* 1. Name

* 2. Age:

* 3. In what city do you live?

* 4. Which of the Iris Circle values are you most interested in discussing?

* 5. Would you prefer for your Iris Circle to meet in person or online?

* 6. When would you like to meet with your Iris Circle? (please select a range- typical meetings would not last longer than 1 hour)

* 7. If there is not an Iris Circle already in your area to meet your needs, would you be interested in starting on?