Apply now to see if you qualify for your

FREE Clarity Session with Polish Peter.

STEP 1 of 2

Please answer all questions below.

Make sure your email/contact info is correct as that's where you'll get access info for

the FREE zoom video coaching session with Polish Peter.

Please note that filling out the form does not guarantee you a spot for the free session.

The free session will be given based on the availability.

After you SUBMIT this form you will complete STEP 2.

First Name

Last Name

Phone *

Best Email Address *

How did you learn about the 1 Conversation Away clarity session? *

Do you have a business? *

Yes

No

What kind of business is it? What do you do? (if you don't have a business, do you want to have one? if not, just say: "I don't have a business") *

What is the #1 thing you want to get out of the session with Polish Peter? *

How badly do you want to have this breakthrough, this change and/or problem solved? *

It's a MUST

It's a should

It would be nice if it changed but...

Ehh, I could take it or leave it

What do you think is the biggest roadblock stopping you from getting what you want? *

In one word, what do you think is the biggest obstacle keeping you away from reaching your goals?* *

If you could wave a magic wand and have a genie grant you any wish, what would you want your life and/or business to look like (say in the next 12 months)? *

Are you willing to be vulnerable with Peter on the call? *

Yes

No

Are you willing to be coachable with Peter on the call? (Coachable means that you are open to hearing something new and the possibility that what Peter coaches you on is true.) *

Yes

No

Free clarity sessions happen every Thursday at 1pm EST (unless rescheduled by Peter prior to the day). Are you able to make that time and be there LIVE, on time? *

Yes

No

At the end of the free clarity session, I'm open to hearing about your coaching mastermind to determine whether or not this would be a great fit for me to help me on my journey. *

Yes

No

Maybe, depending on what happens at the session

I agree that I do not have any medical conditions that could harm me during and after the coaching session. I am not suicidal. I agree that coaching does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association and that coaching is not to be used as a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical or other qualified professionals and that it is the Client’s (my) exclusive responsibility to seek such independent professional guidance as needed *

I Agree

I Disagree

I agree that the free clarity session will be conducted via zoom VIDEO, which means I'll be on video with Polish Peter *

Yes

No

I am open to the session being recorded. *

Yes

No

I agree that everything I said above is to my knowledge, 100% true. *

Clear

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

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AUTHENTIC SELF REBIRTH

After 30 years in America, they call me "The Polish Tony-because when it comes to unlocking your authentic power, I'll pry you open faster than you can say MindSHIFT! In a world full of fake gurus and empty buzzwords, The Authentic Self Rebirth is the 4D mind-blaster that dares you-yes, YOU!-to reclaim your true, kick-butt identity, one page at a time.

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