BECOME by Dr Anderson

Nomination Form (1–5 People)

Use this form to nominate 1–5 participants (including yourself) for the BECOME programme. Nomination is the required entry point for all participants.

How many people are you nominating?

Choose the number of people you want to nominate (Minimum 1, Maximum 5)

1 Person 2 People 3 People 4 People 5 People

Note: For 6 or more people, please use the Group / Organisation nomination pathway.

Your Details (Nominator)

Tell us about yourself. You are making this nomination.

First Name *

Last Name *

Email Address *

WhatsApp Number *

Country of Residence *

City *

Nomination Intent

Are you nominating yourself? *

Yes, I am nominating myself

Yes, I am nominating myself and others

No, I am nominating others

If nominating someone else, what is your role? *

I am gifting this seat to someone

I am sponsoring someone

Other (please specify)

Please specify your role *

Nominee YOU

Provide the details of the first nominee.

First Name *

Last Name *

Email Address *

WhatsApp Number *

Country of Residence *

City of Residence *

Your Relationship to Nominee *

Please specify your relationship *

Message to Nominee (Optional)

(This message will be included in their invitation email / WhatsApp message)

Cohort Selection

Which cohort should the nominee(s) join? *

Choose Cohort *

The selected cohort applies to all nominees in this submission.

Programme Understanding

Please confirm your understanding:

I understand that BECOME is a structured coaching programme (not therapy), that each nominee completes their own onboarding, that coach assignment follows payment confirmation, and that programme fees are generally non-refundable.

WHAT HAPPENS NEXT?

After submission:

You will receive a confirmation acknowledging your nomination
Each nominee will receive an invitation (email and/or WhatsApp) with a unique onboarding link
Nominees must complete onboarding to accept their place
Where enabled, you may track nomination status via your dashboard
Nominees who are also nominators (self-nomination) follow the same process

Questions? Contact: info@becomebydranderson.com

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