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* 1. Tell me a bit about yourself.  What are you currently up to in your life and work?

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* 2. In the next year, what would you like to be different -- internally and externally?

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* 3. If anything was possible ... if you could create anything you want in your life and work, what would that be?

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* 4. First and Last Name

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* 5. Your Preferred Email Address (will not be added to a list)

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* 6. Phone Number (only to be used if we can't reach you via email)

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