First Name *

Last Name *

Phone *

Email *

City *

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What made you apply for The Burnout Reset? *

What are the top 1–2 challenges you're facing right now because of burnout? *

What would change in your life if you rebuilt your consistency and emotional stability? *

How ready are you to take action right now? *

If accepted, are you able to dedicate 2–3 hours per week to this process? *

This program is a financial investment. Are you open to making this commitment if accepted? *

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