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* 1. Name

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* 2. Age:

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* 3. In what city do you live?

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

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

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

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

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