100 Days to Launch Your Practice Pre-Program Questionnaire Please fill out the following. Questions with asterisks * require an answer. Full Name (What do you want us to call you?) Email Your Location (City, State, Country) Your Time Zone Eastern Central Mountain Pacific Are You Available for Daytime Phone Calls? Yes, usually No, never Possibly, if I know ahead of time How long have you worked in INDEPENDENT advocacy? What do you hope to learn and accomplish over then next 100+ days? Anything else you want us to know? OK to add you to the cohort list?We will be making up a list of the people in your cohort to share with the entire group. Name, Location, Email address, and your Niche (if you have one - it's OK if you don't!). Do we have your permission to share your email address and location? (It will not be made available to anyone outside this group.) Yes No Submit
