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Congratulations on becoming a Quit Smoking Coach! We are looking forward to working with you and helping you to be a successful coach with our program.

To get started, simply complete this form along with your payment details.

Your first span of membership will be 12 months. Thereafter, your credit card will be charged annually with the renewal fee of $895.00. If your card number changes or expires through the year, please let us know. Any Quit Smoking Coaches who haven’t paid their membership renewal fee within 7 days will be removed from the website and no longer hold the rights or privileges to use the Quit Smoking Coach program materials. For the full terms and conditions of this agreement, please visit:

Upon receipt of your application, you will receive an email outlining how to log in and download your Quit Smoking Coach manual and other documents. If you have any questions at any time, please contact us on info@quitsmokingcoach.com.au .

About You
Name*
First Last
Email*
Company*
Website*
Your NLP Training
Name of your NLP Trainer
Date you completed your NLP Practitioner Certification
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Miscellaneous
Please let us know more about you:
- I understand that I will be billed in 12 months and then annually for a renewal rate of $895
- I have completed NLP Practitioner Certification Training
- I have completed NLP Master Practitioner Certification Training
- I have completed NLP Trainers Training
Billing Address
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Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Total Amount You Pay Right Now
Quit Smoking Coach Program
Price: $2,495.00
Total amount of $2,495.00 charged today, 1 Payment of $0.00 remaining.
Total
$0.00
I have read and understand the terms of this agreement
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About You

Your NLP Training

Miscellaneous

Billing Address

Total Amount You Pay Right Now

On-Site Registration