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First Name *

Last Name *

Email *

Cell Phone *

What area do you need breakthrough in? *

Give a short paragraph what led up to needing this breakthrough? *

Are you willing to pay a consultation fee? *

(Do you understand that you need to give the minimum fee of $25.00 dollars before the consultant will book a time to chat?)

You Take Full Responsibility

Have you read the prophetic consultations liability release and agree you will not hold the consultant and the named company from any liability as a result of decisions you make after their call with you? Do you take full responsibility for the decisions you make as a result of this call and will you not hold the consultant responsible knowing you are fully responsible to make your own choices after the call?

You Take Full Responsibility *