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Please take a moment to help us get to know you!

Upon receipt of your registration form we will email you a link to secure your desired session time.

Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Do you think you are beautiful?

Yes, most of the time

Yes, sometimes

Yes, but only when I wear makeup or get dressed up

No, I never feel beautiful

How do you think people "see" you?

For example, If you were to describe yourself to somebody, what would you say?

How do other people describe you?

For example, the words my friends use to describe me are typically... kind, loyal, genuine, funny, etc.

We would love to hear your story!

Tell us a little about yourself. For example, What makes you 'you"? What is a struggle you have overcome and how did you overcame it?

How has the struggle you mentioned above made you into the women you are today?

Why do you want to be a part of this project?

Anything else you'd like to share?