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Genius Break Away Wait List
Please complete this form so that you'll be the first-to-know about our upcoming Genius Break Away with Dr. Suzie Carmack May 13-15, 2021 in Isle of Palms, SC (near Charleston, SC)
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Full Name
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First Name
Last Name
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What would you most like to experience in your Genius Break Away
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Time to reset and restore my mind and body
Time to connect and reconnect with friends
Time to recharge my passion for life
Time to reimagine my future (career and home)
All of the above
Other
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E-mail
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Phone Number
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Area Code
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5
Do you have any other insights to share with us for our planning purposes?
EX: Jane Doe, 123 Retreat Road, Laketown, PA 16111, janedoe@retreat.com
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