FIRST NAME

LAST NAME

BEST EMAIL TO REACH YOU

WHAT CITY ARE YOU LOCATED IN?

WEBSITE URL IF YOU HAVE ONE

PHONE NUMBER

WHAT IS YOUR CURRENT MISSION/ PURPOSE /WORK- PLEASE BE SPECIFIC?

WHAT IS YOUR INNER GROWTH EDGE? ARE YOU WILLING TO DO THE DEEP INNER WORK?

ARE YOU FULFILLED IN YOUR BUSINESS OR PROFESSIONAL WORK? DO YOU FEEL YOU ARE MAKING AN IMPACT IN THE AREAS MOST IMPORTANT TO YOU? IF NOT PLEASE EXPLAIN...

WHAT'S THE IMPACT YOU WANT TO MAKE IN THE WORLD?

IN ONE YEAR WHAT GAP DO YOU WANT TO BE CELEBRATING HAVING FILLED? PERSONALLY AND PROFESSIONALLY?

ARE YOU ABLE TO INVEST IN YOURSELF WITHOUT CAUSING HARDSHIP?

DO YOU FEEL FULLY ALIGNED TO A SENSE OF DEEP PURPOSE RIGHT NOW AND IF NOT WHAT FEELS MISSING?

HOW IMPORTANT IS THIS FOR YOU TO SOLVE ON A SCALE OF 1-10 (10 BEING URGENT)

ARE YOU WILLING TO TAKE A DEEP LOOK AT YOUR PERSONAL LIFE TO TACKLE YOUR CHALLENGES? * THIS IS A TRUTH-TELLING COMMUNITY AIMED AT KEEPING IT ALL REAL

PLEASE INDICATE THE FULL NAME OF THE PERSON (IF THERE IS ONE) WHO REFERRED YOU.