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Positive Intelligence Program Registration
All answers are completely confidential and for my organizational purposes only...
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* Indicates required question
Email
*
Your email
Name
Your answer
Preferred email address for the program
The program uses an app, and this email will become your login to it for the next year or longer. You might prefer this
NOT
be your work email.
*
Your answer
Phone Number
*
Your answer
Mailing Address (for book)
*
Your answer
Birthday (year optional)
Your answer
(OPTIONAL & CONFIDENTIAL)
Would you define yourself as neurodiverse? Is there anything you'd want me to know about that?
Your answer
Have you done coaching programs in the past? If so, please share your experience.
Your answer
What do you hope this program will do for you?
Your answer
Questions? Concerns?
Your answer
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