Name
*
First Name
Last Name
Email Address
*
Spouse's name (if married)
Children's name and ages
Current Occupation
I have...(check all that apply)
*
I watched the Start Something Beautiful video
completed the inventory worksheet
my questions written down
How much income per week are you interested in earning?
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$50-$100/week
$100-$300/week
$300-$500/week
$500-$1000/week
$1000+/week
How many hours per week are you willing to put in to your business?
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less than 5 hours/week
5-10 hours/week
10-15 hours/week
15+ hours/week
Are you interested in moving in to a Leadership position, or earning the use of a Career Car?
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Yes
No
I would like more informatoin
What are some of your immediate goals and desires?
Please tell me a little about yourself (family, career, friends, hobbies, or anything you'd like to share with me.)
You will have training and support, however, is there anything you want help with or answered right away?
Submit
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