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Full name

Phone Number (Optional)

Email Address

On a scale of 1-10, how committed are you to work towards transformation (10 being absolutely committed)?

What are the 3 goals you want to achieve in the next 12 months?

What are the biggest challenges you are facing right now?

Name the key people in your life and how they support you.

What is your desired income goal in 12 months?

What would you say have been your greatest accomplishments to date?

What is the most attractive aspect to you about joining the inner circle?

This group is a hand-selected group of people who are ready to really empower their lives. What will you bring to the inner circle?

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