First Name *

Last Name *

Phone *

Email *

Date of birth

What’s your age and occupation? *

What have you already tried that hasn’t worked? *

What best describes your current role? *

What’s your biggest goal right now? *

What’s your current monthly income from your business? *

What’s your target monthly income in the next 6–12 months? *

What’s holding you back from reaching that goal right now? *

Are you in a financial position to invest in mentorship if it’s the right fit? *

Anything else you want me to know before we connect? *

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