🔹 Contact Info Section

Full Name *

Email *

Phone

Instagram or LinkedIn Handle (Optional)

Website (if you have one)

🧠 Business Snapshot

Tell me about your brand or business. Who do you serve and what do you offer?

Where are you currently stuck or stagnant when it comes to building and selling online?

🎯 Goals + Fit

What’s your biggest goal for the next 90 days?

Why do you want to be part of the Media Lab Intensive?

Are you available for 2 live sessions per week (Mon @ 9:30AM & Thurs @ 10:00AM CST)?

Yes

💸 Commitment

Can you make the $5,000 investment if accepted?

Yes

I need a payment plan

If accepted, how soon are you ready to start?

Any final notes, questions, or links you'd like to share?

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By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.