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* 1. What is your request?

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* 2. What products are you considering/do you want to cancel (check all that apply)

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* 3. If you are CANCELLING your service please let us know the reasons to help us improve our service in the future (check all that apply)

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* 4. What is your name?

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* 5. What is your InPower Coaching login email address?

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* 6. If you want us to communicate with you through a different email address, please include it below.

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* 7. How likely is it that you would recommend InPower Coaching to a friend or colleague?

NOT AT ALL LIKELY
EXTREMELY LIKELY
Thank you! We'll be in touch shortly!

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