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.
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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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