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* 1. Please enter your name

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* 2. Please enter your email

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* 3. Is your career 

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* 4. How many years have you worked in your current career?

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* 5. Do you feel stuck, frustrated, lost, bored, or limited by your current career trajectory?  Check all that apply.

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* 6. Have you identified your career goals for the next 1 year, 5 year, 10 years?

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* 7. Overall are you happy with your life today? Check the boxes that best apply to you.

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* 8. Have you had the opportunity to work with a personal life coach/ career coach, mentor, or even a personal fitness coach in the past? Someone who works with you one on one to help you elevate your life?

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* 9. Do you feel ready to take massive action to live your life on a new level?

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* 10. What would be your #1 question for the CPAC career coach/life coach team if you could only ask one question?

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* 11. Do you have favorite hobbies or pass times?  Please enter below:

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* 12. Please Read our TERMS and CONDITIONS.

By entering your name on the line below and completing this questionnaire you certify that you have read, understand and agree with our terms and conditions if you decide to participate in the Free 5 Day Challenge.

TERMS AND CONDITIONS:  CPAC Consultants are PAs and life/career coaches with various business experience including medical practice management and business ownership. CPAC Consultants coach, guide, and advise clients based on years of experience, historical industry data, and based on their opinions. CPAC Consultants are not attorneys and therefore do not provide formal legal advice. Any and all outcomes, including employment related outcomes, of any coaching services and "challenge" programs are the full responsibility of the client and are not guaranteed by CPAC, and you agree to hold CPAC and it's consultants free from any responsibility and liability resulting from the outcome of participating in this program.  

I have read, understand and agree to the above Terms and Conditions:

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