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1
Name
First Name
Last Name
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2
Email
example@example.com
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3
Have you worked with PALM before?
6-Month Start Up
12- Month Business Builder
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No I have not
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4
What city & state is/will your Assisted Living be located?
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5
Who's on your team?
Just Me
My Spouse is my business Partner
I have Business Partner(s)
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6
Current Employment Type
W-2
Self employed-Solo Entrepreneur
Business Owner
Real Estate Investor
Not Currently Employed
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7
Industry Experience
Medical
Real Estate
Business
Admin
Other
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8
Why are you wanting Private Mentorship?
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