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* 1. First and Last Name

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* 2. Email Address:

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* 3. What are the 3 biggest leadership challenges you are facing right now?

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* 4. What changes would you like to make in those areas during this coaching journey?

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* 5. If you would have a magic wand, what's one thing you would change?

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* 6. I am very committed to improve/ transform myself as a leader

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* 7. Any additional input you would like to share?

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