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* 1. First and Last Name

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* 2. Email Address:

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* 3. What are the 3 biggest challenges you are facing right now?

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* 4. What changes would you like to make in those areas during this coaching journey?

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* 5. If you would have a magic wand, what's one thing you would change in your life?

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* 6. I am very committed to improve/ transform myself/my life?

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* 7. Final Words!

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