Thank you for your interest in the Blue Islands Fear of Flying course, we would like to get a few details and understand a little detail about your fear of flying and how much it affects you.

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* 1. What is your full name?

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* 2. On a scale of 0-10, how uncomfortable are you with flying?
(0 = no problem, 10 = I cannot get on a plane, even if it would save my life)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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* 3. Please use the comment box below to tell us about your fear of flying

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* 4. What is your email address? (this will only be used to contact you in relation to the Fear of Flying course).

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* 5. Please provide a contact telephone number

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