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* 1. First name:

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* 2. Last name:

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* 3. E-mail:

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* 4. Mobile phone (with country code):

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* 5. Home country:

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* 6. Country of residence:

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* 7. What would you like to share with the community of practitioners regarding your experience?

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* 8. Which certifications do you have?

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* 9. In which language(s) can you coach?

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* 10. How many times have you applied LCP or CLA?

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* 11. How do you prefer to be contacted?

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* 12. If you use LinkedIn, you can share here your URL:

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* 13. “I hereby authorize Leadership Circle to share this information with the community of practitioners for work collaboration.”

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