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6-Week Relationship Make Over Application
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* Indicates required question
Name
*
Your answer
Email
*
Your answer
Phone
*
Your answer
What is your great struggle in your relationship right now? If you are single, what is the issue you have struggled with most in the past?
*
Your answer
What other challenges or frustrations do you experience in your relationship dynamics or dating
*
Your answer
On a scale from 1-5, how important is it for you to find a solution?
*
It's not really important
1
2
3
4
5
OMG! It's HUGELY important
What have you already done to address this issue? (coaches, workshops, counseling, books, etc.)
*
Your answer
What is your current relationship status?
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Your answer
How did you hear about the course?
*
Facebook post from Jason
Facebook post from Mariah
Google search
Recommendation from a friend
LinkedIn
Email marketing from Jason
Other:
What is your age?
*
Under 18
18-29
30-39
40-49
50-59
60-69
70+
Is there anything else we should know?
Your answer
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