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* 1. Please fill in your contact information:

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* 2. What would you like help with?  Check all that apply

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* 3. Choose all options that you would love to experience and that you would be willing to invest in for yourself

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* 4. Who was your favorite speaker on the Alchemy of Ascension II? (name up to 3)

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* 5. What is stopping you from living your best life right now? choose all that apply

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* 6. How can I best support you on your path at this time?  (and/ or) What would you like me to know about you?

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