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The Reserve Bali Application
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Email
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Your email
Full Name
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Your answer
Age
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Your answer
What is the longest period of sobriety you've experienced?
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Your answer
How many times have you been to rehab for substance abuse?
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Your answer
How many times have you been in sober living?
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Why do you want to come to The Reserve Bali?
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Who else in your life would benefit from you coming the The Reserve Bali?
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