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* 1. Name

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* 2. Email address

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* 3. Cell phone number

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* 4. Address

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* 5. What most interests you about this program?

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* 6. What do you hope to gain from this program?

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* 7. Describe any current practices and how often you practice them.

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* 8. Are you available for all of the program dates? If not, which ones are you unable to attend? (please find the dates at www.shineakron.com/mastery)

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* 9. Please share anything else you might want us to know.

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* 10. How did you hear about this program?

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