Name

First Name

Last Name

Phone Number

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What city do you live in?

Why are you interested in the single mom's mindset development group?

What are the biggest challenges you are currently experiencing as a single mom?

What are you doing to overcome these challenges?

What are you interested in learning more about that would be beneficial to you?

Are there any habits or behaviors that you would like to develop?

Are there any habits or behaviors that you would like to eliminate?

Would you see value in spending 30 minutes per week (by zoom) with other single moms working together to improve in areas of your choice?

If you answer yes, how do you see yourself benefitting?

Are you currently reading any instructional/self-improvement books?

If yes, how often would you say that you read?

You won’t want to miss out on this complimentary life-changing experience! Fill out the questionnaire below to be considered for our annual Summer Retreat June 13-15, 2024 where we will:

1. Provide a Forum for single moms to form relationships of trust and friendship.

2. Introduce Informative and motivating workshops.

3. Provide and form mastermind groups for personal development that will build skills and confidence for years to come.