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12-Week Evolutionary Gentleman's Program
Application for Consideration to Participate
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* Indicates required question
Name
*
Your answer
Email
*
Your answer
Phone
*
Your answer
What is your current relationship status?
*
Your answer
What is your biggest frustration with women?
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
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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