Rewire Intake Survey

Love, Sex and Money

Please fill out the Rewire intake survey below to help us make sure that we serve you and help you meet your specific outcomes at the Rewire 3-day event.

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Full Name*

Email*

Location where you’ll be signing in from (City/Country)*

What are you hoping to experience at your “Rewire” training?*

What is your biggest obstacle in your own particular “Trauma Story” that you’d love to gain more clarity on?*

In other words, what insights would you have to gain in order to make your time at Rewire transformative for you?

What is something that you've hit a ceiling or a snag around in regards to your Sexuality and Sex Life in general that you would love expansive & inspiring guidance on?*

What is something that you've hit a ceiling or a snag around in regards to Money and Prosperity that you would love expansive & inspiring guidance on?*

Have you carefully checked the time zones in your area and planned (with child care and meals) your schedule around being able to be present for the entirety of the Event?*

The program has been carefully curated to ensure you’re having enough time and space and rest to allow the transmission of the material to integrate. Any deviations from the program as intended becomes an obstruction to your results and transformation. This is a critical part— and we take your investment seriously. Are you all- in with being able to show up fully present?

Anything further you want to share about your story or something you want to share to help us ensure you have an EPIC experience? This is about you, after all.*

CRITICAL: Can you please upload a photo of a younger picture of yourself— this will be an important part of the content of the curriculum on Saturday evening.*

This photo will not be used for any other purpose— outside of the container and will be a part of a gift that will be presented to you after the event is finished.

Max. file size: 256 MB.

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