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We’re looking forward to getting to know you better to see how our team can best support you and your business. Congratulations on taking the next step in your growth!

Please answer the following questions with as much detail as possible.

If it’s a fit, the team will invite you into the program that our team feels is best suited for the level of support requested or needed.

Name *

First

Last

Email *

Phone *

Birthday (Month, Day, Year) *

Shipping Address (We like to mail gifts to our clients.) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What industry are you in? *

What was your revenue in the last 12 months? *

What is your target revenue? *

When you close your eyes and envision your dream life, how is it different than your life right now?

What do you think is the biggest barrier keeping you from your goal? *

Can you identify with any of the following? *

High Functioning Anxiety
PTSD/C-PTSD
Career transition
High performance pressure
Something feels like it is missing
Lack of support personally and/or with my team professionally
Feeling isolated or alone in my growth
Struggle to set boundaries
Lack clarity about what's next
Seeking personal growth

What programs have you previously invested in? Please list. *

How ready and committed are you to invest in your business growth at this time? *

Which specific program with Keri are you applying for? *

Why do you believe this program is the best fit for the support you need at this time? *

If accepted, what outcomes do you expect to achieve by participating in the program? *

If accepted, how soon are you looking to get started? *

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DISCLAIMER: The results stated on this website are of previous or existing clients. Results are not typical and may vary depending on many factors including but not limited to your background, experience, implementation and expertise. References are for example purposes only.

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