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Questions marked with a * are required Exit Survey
 
 
Name
   
 
 
 
Country
   
 
 
 
E-mail
   
 
 
 
Skype name
   
 
 
 
Skype name
   
 
 
 
Mobile nr.
   
 
 
 
What is the reason you seek extra wisdom for? (What is the subject, the dilemma you want a wise ‘answer’ for.)
   
 
 
 
What makes you smile when we end our session? (What do you hope from our session to make it (very) useful for you?)
   
 
 
 
When / About what do you feel good regarding the reason you seek wisdom for?
   
(What are you proud of – glad with – enjoying, etc.)
   
 
 
Contact Information
* First Name : 
* Last Name : 
Address 1 : 
Address 2 : 
City : 
State : 
Zip : 
Phone : 
Email Address :