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         ENROLLMENT FORM  –  AYHB PROGRAM



Contact info…
Name:  

Cell Phone #:
Address:

City/State/Zip:
Email:

Business info…

Company:

Years in Biz:
Website:

Phone  #:

Getting to know you…
Describe your biz:
What is your full-time job?
What services/products do you currently offer?

What are some of your current challenges, obstacles or roadblocks in your biz/life?

List 3 short-term goals you would like to work on with measurable results – in the next 3 mos.?


What would you like to work on in the next 6 months? (Keep it realistic but reach a bit!)

Where do you want to see your biz in the next 12 mos.?_____________________________________________________________________________________________________________________

 
CURRENT BILLINGS:  Under $30K _______           $31K - $75K ______           $76K+ ______


AWAKENYOURHOLISTICBUSINESS@GMAIL.COM                                     914.266.0807