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* 1. What is your current relationship situation?

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* 2. What's your current attitude towards finding a life-partner?

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* 3. What have you currently been doing to find dates?

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* 4. What are your feelings towards online dating?

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* 5. What do you have to offer a life partner?

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* 6. Why are you interested in participating in this women's coaching group?

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* 7. How did you hear about the program?

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* 8. Full Name and City

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* 9. Email Address

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* 10. Phone Number

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