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* 1. Full Name

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* 2. Address

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* 3. Phone Number

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* 4. Email Address

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* 5. Describe your current work: title, field, role, length of time in this position

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* 6. What are your current challenges professionally and as a leader? 

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* 7. What are your current challenges personally?

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* 8. Tell us about your interest in Aurums' Women's Leadership Circle and what you hope to get from it?

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* 9. Tell us about your past experience with leadership development, coaching and/or personal development.

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