Legacy Executive Program Application

Full Name

What's the primary reason you're seeking this type of experience?

Physical performance optimization

Mental clarity / nervous system regulation

Recovery / injury prevention

Stress and fatigue management

Breath dysfunction correction

Leadership capacity and presence

Preparing for a specific event or season

Personal development / transformation

Other (please specify): ___________

Phone *

Email *

Occupation/Role

City

What are your current performance, leadership, or wellness goals?

How would you describe your current breathing habits or awareness?

What’s one pattern, challenge, or behavior you’ve struggled to change—even though you’ve tried?

Why now? Why are you ready for this level of work?

Are you willing and able to schedule the time and presence required to learn and implement the methods? Although there will be follow-up after our initial two days, this immersion is designed to empower you move forward with confidence in your new tools.

Yes

Depends on location/travel plans

Price points start at $3,500. Are you comfortable investing in a high-level, private coaching experience?

Yes

I’d like to discuss options

How did you hear about Breath Factor or Rob Daniels?

Anything else you’d like to share or ask before the call?