* First Name: Last Name: * Address 1: Address 2: * City: * State: - Choose State - AL-Alabama AK-Alaska AZ-Arizona AR-Arkansas CA-California CO-Colorado CT-Connecticut DE-Delaware D.C.-Dist. of Columbia FL-Florida GA-Georgia HI-Hawaii ID-Idaho IL-Illinois IN-Indiana IA-Iowa KS-Kansas KY-Kentucky LA-Louisiana ME-Maine MD-Maryland MA-Massachusetts MI-Michigan MN-Minnesota MS-Mississippi MO-Missouri MT-Montana NE-Nebraska NV-Nevada NH-New Hampshire NJ-New Jersey NM-New Mexico NY-New York NC-North Carolina ND-North Dakota OH-Ohio OK-Oklahoma OR-Oregon PA-Pennsylvania RI-Rhode Island SC-South Carolina SD-South Dakota TN-Tennessee TX-Texas UT-Utah VT-Vermont VA-Virginia WA-Washington WV-West Virginia WI-Wisconsin WY-Wyoming * Zip Code: * Business Phone: * E-mail:
What industry do you work in?
Are you in a position of leadership?
Do you have any experience with personal development, coaching, or assessment?
If you could have one thing to make yourself more successful, what would it be?
How much do you enjoy your work?
Choose One
1-Not at all
2-Not so much
3-Yeah, I enjoy it
4-I really enjoy my work
5-I never thought I'd love it so much
To what extent do you feel that you have clearly defined goals in you life and work?
Choose One
1-What?
2-Yeah, ok, goals
3-I have goals, I think
4-My goals are clear
5-I know exactly where I am going
To what extent do you have a sense of Balance in your life and work?
Choose One
1-Totally out of control
2-Surviving but uneven
3-I get by OK
4-Doing pretty well
5-I have found nirvana in my Zen garden
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