Name
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First Name
Last Name
Email
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Phone
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Country
(###)
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Your Time Zone
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Atlantic
Eastern
Central
Mountain
Pacific
Hawaiian
UK
Other
Country
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Describe your current or most recent role (including your job title), industry, and location.
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How far along are you in your career? How many total years of experience do you have?
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What are your 3 top successes in life and/or career?
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What’s going really well in your professional life right now?
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What single thing is holding you back most right now?
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What other fears, frustrations, or challenges are in the gap between where you are now and where you want to be?
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What are your expectations for our work together? What will succeeding at this thing change about your life? And why is this important?
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How can we exceed those expectations together?
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Imagine your life 10 years from now. What impact are you making in the world?
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What else is helpful for me to know about you?
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We work on a retainer/program basis, which range from $24,997 down to $7,997 USD. Are you willing to invest to fill that gap between where you are now and where you want to be?
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YES
NO
Can you make buying decisions or do you need someone else’s permission?
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YES, I make my own buying decisions.
NO, I need someone else's permission.
If you qualify, when would you want to start?
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As soon as possible
With the next few weeks
Next month or after