First Name

Last Name

Business or Company Name

Email Address

Best Number To Reach You At

Best Time To Call Best Time To Call Afternoon Evening No Preference

Website Address (If You Have One)

Did You Wishing To Work Specifically With Cathy Or Lesley Did You Wishing To Work Specifically With Cathy Or Lesley Cathy MacRae Lesley Plumley No Preference

Which Program Do You Prefer? Which Program Do You Prefer? I am interested in the 5-session program ($950 CAD + 5% GST) I am interested in the 10-session program ($1500 CAD + 5% GST)

Payment Plan - Would you prefer to pay in full, split payment into 2 or 3 payments, or pay monthly? Payment Plan - Would you prefer to pay in full, split payment into 2 or 3 payments, or pay monthly? Full Payment Split payment into 2 equal payments Split payment into 3 equal payments Pay monthly

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Tell Me About Your Business and What Changes You Would Like To See Happen

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