Cord Cutting Ceremony Registration Form
In order for us to get started I need some information to help ensure depth in our work together. Please fill out this form and use the payment option provided to reserve your spot.
What is your full name? *

What's your Skype ID and/or Facebook name?* *

If possible, please provide both.
What country and time zone do you live in?* *

Please provide the correct time zone.
How did you hear about me? *

Thank you for filling out this form!

You will receive an automated email with a link to my calandy to set a date.

I look forward to working with you!
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