Phone Numbers:
Home:______________

Work:_______________

Pager:_______________

Cell:________________

Email:_______________

Fax:_________________

Best time to call:_______

Name____________________________

Nickname__________ID#___________

Address__________________________

_________________________________

City________________ST___Zip______

Occupation______________________

Spouse?_______Supportive?________

Your main interest is in:

_____Business

_____Health

_____Survival/Help

Your Personality Type:

_____Analytical

_____"Driver"

_____Expressive/Friendly

                                                Interview

1. Why did you decide to become involved with American Longevity

2. What does success look like in 6 months?
        How about 1 year_____5 Years_______

3. What would you change about your current career?
          More time? More money? More freedom?

4. What is your biggest health chalenge?

5. What are your biggest fears about this industry?

6. If you could design the perfect life, what would it look like?

7. Do you think you can commit to doing what it takes to achieve your
    dreams?

  When finished e-mail to your Mentor or call them to discuss your goals .