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First off, what’s your First and Last name?

What is the best email to reach you at?

What city/state do you reside in?

What is that best number to reach you at?

What is your age?

What is your occupation?

Please pick your current annual income: Please pick your current annual income: $0 - $50k$50k - $100k$100k - $200kAbove $200k

Have you worked with a dating coach before? Have you worked with a dating coach before?YesNo

What do you feel, you need the most help with?

If NYC Wingwoman team could magically make anything possible, what would your ideal situation be?

What about dating is most challenging for you? The NYC Wingwoman team only accepts a very limited number of new applicants each month to work with one-on-one for their paid coaching program. Why should they select you?

On a scale from 1-10 how ready are you to invest and take action to change your love life? On a scale from 1-10 how ready are you to invest and take action to change your love life?12345678910

How soon are you ready to start? How soon are you ready to start?ImmediatelyThis WeekThis MonthMaybe Later