Financial Support Form

1

Name* This field is required.

First Name

Last Name

2

Phone Number (with country code)* This field is required.

+9xxxxxxxxxx

3

Email Address* This field is required.

example@example.com

4

Languages comfortably spoken* This field is required.You can select more than one

English

Arabic

5

Country of Residence* This field is required.

6

Age* This field is required.

7

Why you want to join this course?

8

How you feel this course will help you?* This field is required.

9

What do you do?* This field is required.

10

I can afford to pay blanks *

11

Is there an experience you have experienced which you would describe as sexual trauma/abuse?* This field is required.

Yes

No

Other

12

Anything else you would like to share?

13

Select the course you are interested in:

A Guide to Penetration

What you Wish you Knew about Pleasure

Heal Your Relationships

Other

14

How did you find my course?

Instagram

A Friend

Podcast

Other