Welcome to EC Club!

Application Form

We’re looking forward to learning about what you do, so please fill out the form to get things started.

Name *

First

Last

Email *

Which membership option do you want to join?

Business Name *

Phone *

Website / URL

Please list any social media handles you are on

Where is your business located? *

What business offerings do you have?

Type of Business/Niche

Please add a bio/ describe you & your business in less than 100 words *

Please describe your ideal client/customer *

Please describe the products or services you offer. *

Who or what type of people/niche are you keen to connect with? *

Who can we thank for your referring you or how did you hear about Empowered Connections club?

Are you interested in the Upgrade to be listed on a public directory on the UpYourBrave.com website? Pending approval

Are you interested in learning about 1-1 or group coaching for your business? *

Please upload your headshot and 1-2 other brand/product or logo images. *

Click or drag files to this area to upload. You can upload up to 4 files.

Name