GET ME STARTED NOW Account set up form First* Middle Last Name Company* Phone* Fax E-mail* Contact Details Address* Type of Leads* Lead Types 10 Standard One on One coaching leads 5 Customized One on One 10 Group coaching leads 1 Coaching Website Define your ideal lead Your preferred industries* Preferred Industries Manufacturing Retail Hospitality Wholesale Construction Any other, please specify. State you are located* Location NSW VIC QLD WA SA NT ACT Tasmania Your preferred zip codes Do you send any information prior to meeting up with a prospect? Yes No Delivery Time frame* Time in Weeks 1 to 2 Weeks 2 to 4 Weeks 4 to 6 weeks You heard about WBS from* Reference Source Cyrus mail merge Search Engine From a coach Any other, please specify Phone no’s of your prospective clients, and businesses you have already coached. (We will filter them from our master database) 1.* 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. If you want other coaches to know about our services, please write their email and WCL info pack will be emailed automatically. Your birthday* Month Date Year Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 I agree to the terms and conditions*