Form

Thank you for your application.

Your request has been successfully received.

My assistant will personally review it within a few days.

If your application passes the initial screening, you will proceed to the next steps to see if we are truly a match and can work together.

Personal Information

Name and Surname

Age

Telephone Number

Profession

Address

Country

Language

Interest Area

Motivation and Personal Readiness

Why have you decided to apply for the DualMent program?

What is the most radical change you want to achieve?

What has held you back so far from reaching your highest goals?

What has been your toughest failure? How did you get back up?

Are you ready to look inside yourself without filters, even when it hurts?

Yes No

Commitment and Attitude

Are you willing to work even when there are no applause or immediate results?

Yes No

Have you already followed personal or professional growth programs?

How much time and energy are you ready to dedicate each day?

Less than 1 hour 2-5 hours More than 5 hours

Willing to follow the DualMent method 100%, without modifications or shortcuts?

Yes No

Results and Goals

What are your current real and long-term goals?

What drives you to achieve them? Where does your motivation come from?

When you face an obstacle, how do you react?

Financial Availability and Commitment

The program requires an average financial investment of €8,900. Are you able to afford this?

Yes No

Do you understand that the value of the program is determined by your commitment, not just by money?

Yes No

The process works only with full commitment. Are you willing to fully respect this?

Yes No

Compliance and General Attitude

Will you follow all the rules and guidelines provided during the program, without exceptions?

Yes No

Do you agree not to manipulate the method to fit your habits?

Yes No

Are you aware that I do not offer shortcuts, quick fixes, or compromises?

Yes No

Are you willing to step out of your comfort zone to truly transform?

Yes No

Final Declaration

Why do you believe you are a suitable person for this program?

Do you agree that this application represents only the first step?

Yes No

I declare that I have understood that:

The program is not a therapy nor a substitute for clinical treatments. It is not intended for the diagnosis, treatment, or cure of medical or psychological conditions. I participate autonomously, with full clarity and awareness, without any need for psychotherapeutic support. I am seeking a transformative, non-clinical experience focused on improving my mindset and behavior.

I confirm that I have read and understood the above and agree to participate in the program with full responsibility.

Do you confirm all of the above?

Yes No

I have read the privacy policy and consent to the storage of my data in accordance with the European Regulation on the protection of personal data No. 679/2016 (GDPR), in order to receive information about the services of dualment.com. I consent to the processing of my sensitive data that I choose to share with the data controller.

Thank you for your application.

Registration form

Personal Information

Motivation and Personal Readiness

Commitment and Attitude

Results and Goals

Financial Availability and Commitment

Compliance and General Attitude

Final Declaration