Interested in our upcoming Create Work You Love online Career Program? Fill out the form below to apply for a 1:1 call with Vanessa! Name* First Last Best Email Address* PhoneWhere do you live?* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country How did you hear about this program?* Friend / Family / Colleague (let us know who referred you in "Other" below so we can thank them!) Vanessa spoke at your company or an event (please list where in "Other" below) From Vanessa's website or newsletter Forbes article Huffington Post article Fast Company article Insight Timer Facebook Twitter Google Search From Vanessa & Lisa's newsletter (MBA) Other OtherWhat's your LinkedIn profile? (if you have one) (ex: http://www.linkedin.com/in/vanessaloder)* What's your biggest struggle when it comes to creating work you love? What’s frustrating or painful? What do you wish you could change or make different and why?*What's the worst case scenario related to your work situation - the one fear that keeps you up at night?*Why are you interested in Vanessa's "Create Work You Love" Program at this time? Be specific.*What would you like in your career and life? Where would you like to go next?*If there was a dream solution for you and your career that could magically appear and unfold perfectly, how would that story go?*What's stopping you from moving ahead?*When you think back on other transitions you've been through in the past, what helped you navigate those transitions?*Are you willing to commit at least 6 hours a month for three months as a participant in this program?*YesNoMaybeIf you were to look back in three months and say "Wow! I can't believe how much things changed as a result of that program," what will you have received?*If you find this program valuable, would you be willing to share it with at least three (3) friends?*YesNoAnything else you'd like me to know?