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Your WINS are Important to Us!

. . . 

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Question 1 of 13

What is Your Full Name?*

Question 2 of 13

What is Your Email Address?*

Question 3 of 13

Which of Vera's Courses are you enrolled in? 

(Select all that apply)
A

The Authentic ME

B

The Assertive Alchemist

C

The Love Creator

D

The Master Manifestor

E

From Conflict to Ultimate Love

F

Authentic Communication That Works

G

Other

Question 4 of 13

What do you currently do? What is your profession? 

Question 5 of 13

What are your passions and inspirations?

Question 6 of 13

What results were you hoping for when you purchased Vera's course?

Question 7 of 13

Did her course help you accomplish those? 

Question 8 of 13

What A-HA moments have you experienced in your life during your journey through Vera's course?

Question 9 of 13

What #WIN have you experienced because of taking Vera's course?

Question 10 of 13

If you were to suggest Vera's course to a friend, family member or a colleague, what would you tell them? 

Question 11 of 13

Your testimonial is important to us and our future students. Would you like to share your story and how this course helped you in life and relationships? 

Question 12 of 13

Please, upload your headshot that we could use to share your #WIN. 

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Question 13 of 13

By checking the box below, you hereby permit and authorize Vera Velini and The Velini Academy (Velini Wellness, Inc.) to use your name, image, professional and personal biographical information as part of a testimonial for the company's products and services. 

A

YES

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