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Application Form

Application Form

First Name

Last Name

Email

Phone Number

What are your reasons for wanting to take part in this program?

The Valor Progamme has a private online community on two social networks. Which would you like to be a part of?

Facebook & LinkedIn

Only Facebook

Only LinkedIn

I do not want to join a community

I understand that I am wholly responsible for cultivating positive change in my life, and that my participation does not guarantee a particular result. I acknowledge that as with any health-related program or service, my individual circumstances and committment will determine my outcome *

I confirm I have the time and energy to participate fully in this program/course and will complete it to the best of my abilities *

Thanks for submitting!

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