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15
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1
Name
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First Name
Last Name
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2
Email
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example@example.com
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3
Phone Number
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Please enter a valid phone number.
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4
City
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5
What is your dream goal?
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6
How much time do you spend on fulfilling your dream goal?
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7
On the scale of 1 to 10, how much you rate yourself in achieving your goal??
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8
Do you find yourself stuck??
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YES
NO
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9
Your age ranges between?
25-30 years
30-40 years
40-50 years
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10
Do you feel overwhelmed or unable to cope with your responsibilities?
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YES
NO
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11
Do you have any specific problem?
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12
What are techniques you have already applied?
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13
How badly on a scale of 1-10 you want to transform yourself to reach your goals??
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14
What is current monthly income??
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15
If you get scientifically proven methods and time-tested strategies to transform your current life to desired life and achieve freedom from your problem, how much you are willing to invest on yourself?
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Rs.5000
Rs.10000
Rs.25000
Money is not important
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