Fill out this short form to reserve your place. If you are interested in the Binge Code Recovery Coach certification, please fill out this form below. If you need help with the form contact us on training@bingecode.com. After submitting your application our team will review it and get back to you within 2 working days.First NameLast NameAre you over 18 years old?[ ] Yes[ ] NoEmail AddressPhone NumberWhy do you want to become a Certified Recovery Coach?Have you ever suffered with an eating disorder? If so, when and how did you recover?If you have suffered with an eating disorder in the past. How long have you been in full recovery? Over 12 months Under 12 monthsDo you have any experience working with eating disorder sufferers (or other relevant support work/etc experience)?How did you hear about the Binge Code Certified Training Program?Anything else you wish to add?Which Package are you interested in?|[ ] Core Training Package[ ] Business Kickstart Pack By submitting this application, I affirm that the information provided is true and complete. I understand that any false statements or mis-representations made by me on this application may result in my dismissal from the program.Submit Application Form