Please complete all the fields with as much detail as you can so that I can get help to the best of my abilities. First Name* Last Name* Email Address* Street Address* City* State* Country* Telephone* Skype User Name* How did you hear about Nicole Justine?* ---YelpInternet SearchReferralOther Why are you interested in working with Nicole Justine Reid?* In what ways do you feel you are not fully living up to your potential?* What do you imagine unleashing your potential would be like for you? What do you see, hear, or feel?* What about the Ultimate Transformational VIP Day Experience are you drawn to?* Why now?* If you sense you have a mission or a purpose here on earth, what might it be?* What else have you been doing to support yourself on your spiritual path?* Describe your current relationship with God/Source/Universal Energy/your name for this higher power is.* What are your biggest challenges to fulfilling your potential right now?* On a scale from 1 to 10 (10 being highest), how important is it for you to fulfill your potential and expand into all of who you are as a spiritual being and earthly being?* ---12345678910 On a scale from 1 to 10 (10 being highest), how ready are you to invest time, energy, and money into your finding that sense of fulfillment?* ---12345678910 On a scale from 1 to 10 (10 being highest), how ready and committed are you for transformation now?* ---12345678910 By submitting your application, you will be added to Nicole Justine’s e-communication list so that you will receive the next steps regarding your complimentary session. You will also receive supportive emails about how to unleash your potential, which you can opt out of at any time. We will never mistreat your information in any way and we thank you for joining our community!