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HELLO + WELCOME
To ensure our collaboration is a match made in heaven, I need just a sprinkle of your magic. Please take a moment to complete this form – it's your gateway to a journey filled with wonder and impact.
19
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1
Name
Wahoooo! Lets do this, include your full name below:
First Name
Last Name
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2
Email
example@example.com
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3
Where in the world are you making your mark?
In the spirit of Carmen Sandiego, Drop us a clue with your city and state!
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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4
Phone Number
Please enter a valid phone number.
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5
Now, let's get to know you better! Whether you're running a business, leading a community, ministry, non profit, or even in the exciting stages of conceptualizing a new venture, we'd love to hear about it.
What are the key products or services or activities, or ideas that you're passionate about bringing to life?
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6
Time to Choose Your Adventure: Which Community Cultivator VIP Experience is Calling Your Name?
Please Select
Option 1: Strategy VIP Day – Focus on strategic growth in either an inspiring virtual setting or an in-person session in San Diego or Italy. (Get in on the action – just 2 spots per month, so grab yours pronto and let's roll!)
Option 2: Creative VIP Day – Dive into a world of creativity and branding. This is perfect for amplifying your presence and making a significant impact. (Only offered 4 Times a Year)
Option 3: The Full Spectrum – Combine the best of both worlds! If you're enthusiastic about experiencing the complete range of what we offer and are ready to fully immerse yourself in both Creative and Cultivator VIP days, let us know. This option ensures a comprehensive journey, covering every aspect of creativity, strategy, and business growth.
Please Select
Please Select
Option 1: Strategy VIP Day – Focus on strategic growth in either an inspiring virtual setting or an in-person session in San Diego or Italy. (Get in on the action – just 2 spots per month, so grab yours pronto and let's roll!)
Option 2: Creative VIP Day – Dive into a world of creativity and branding. This is perfect for amplifying your presence and making a significant impact. (Only offered 4 Times a Year)
Option 3: The Full Spectrum – Combine the best of both worlds! If you're enthusiastic about experiencing the complete range of what we offer and are ready to fully immerse yourself in both Creative and Cultivator VIP days, let us know. This option ensures a comprehensive journey, covering every aspect of creativity, strategy, and business growth.
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7
Alright, time for the biggie – Envision your ideal outcome for your VIP Strategy Day. What specific goals or achievements are you hoping to attain from this experience?
We know, it sounds like a tall order, but hey, let's start dreaming big together! Share some of those grand visions, perhaps where you'd like to get clearer and let's start map out a grand adventure together.
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8
Personality Profiles: We're talkin... Enneagram, Myers Briggs, Strength Finders, Disc, Love Languages, Whats your Puppy Personality (LOL) - have you done any of these in past and recall your results? If so please type them below....
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9
Short Term Goals (0-90 Days), Your 1 Year Goal & How about over the next 3 to 5 years?
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10
What are some of the current challenges and roadblocks?
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11
Brands and People that inspire you...
Even better if they are in your same sphere of influence
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12
What Growth Tools have you invested into over the last few years (Coaching, Courses, Schools)
You name it.
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13
If Yes to the above - what were the strengths and was there anything that felt lacking?
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14
Spill the beans – what's your go-to coffee creation? Or do you have another favorite sip that gets you buzzing?
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15
Snack Time Secrets: Spill the goodies! What snacks do you stash away for that perfect crunch, munch, or sweet delight?
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16
Your Birthday Bash: What's the big day?
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17
How do you envision joining our Community Cultivator VIP Day? Are you excited to embark on a journey and meet us in person, perhaps in sunny San Diego or beautiful Italy? Or would you prefer to connect from the comfort of your space, making magic happen virtually? Let us know your preference!
San Diego or Bust
Virtual Livin Room Babyyy
You Had me at Italyyyy (Spring or Fall)
Tiff, can you come to me?
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18
2024 Dates
Feb (Full)
March
May
June
September
Other
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19
Is there anything else you'd like us to know or any special considerations you'd like to share? Feel free to jot down any thoughts, ideas, or extra sparkle you'd like to sprinkle on your VIP Day. We're all ears and eager to tailor this experience to be as unique and fabulous as you are!
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