IIC&M Professional Membership:

IIC&M Accredited Membership:
Professional Master Mentor (IIC&M)
Accredited Master Mentor (IIC&M)

Accreditation Expiry Date:
30th June, 2017



This is the country in which the coach, mentor, or their business is located.
This does not mean that the Coach or Mentor restricts their business to just this business location.

United Kingdom




A few words from Adam

A few words from Adam


Type of Coaching or Mentoring

Type of Coaching or Mentoring


Contact Adam

Contact Adam

When you press send at the end of this form, an email will be sent to Adam, with all the information you have entered in the form below. Your email address is mandatory as this will allow Adam to respond. The telephone number and skype fields are optional as you are able to select whether Adam should contact you by telephone, skype or email. Please note that your email address will not be stored anywhere other than on the email you are now sending to Adam.

Your Name (required)

Your Email (required)

Country of Residence (required)

Telephone number

Skype ID

What is your occupation? (required)

Are you looking for a Coach or a Mentor? (required)

What sort of coach or mentor are you looking for? (required)

How would you like to be coached or mentored?

How did you find out about the IIC&M? (required)

Any further message?