FALL 2023 MENTORSHIP NAME * First Name Last Name ARE YOU A CURRENT OR PREVIOUS MEMBER OF MY MEMBERSHIP? Yes No TELL ME ABOUT THE WORK WE'VE DONE TOGETHER (1:1 or GROUP WORK) ARE YOU INTERESTED IN BUSINESS/PROFESSIONAL MENTORSHIP OR INTUITIVE/PERSONAL HEALING MENTORSHIP? BUSINESS HEALING / INTUITIVE DEVELOPMENT BOTH WHY ARE YOU INTERESTED IN 1:1 MENTORSHIP? WHAT ARE YOU LOOKING TO RECEIVE FROM THE EXPERIENCE WORKING WITH KATE AND INVESTING IN YOURSELF? * PREFERRED MENTORSHIP FORMAT 3 MONTHS | BIWEEKLY MEETINGS (6 SESSIONS) 2 MONTHS | WEEKLY MEETINGS (8 SESSIONS) Thank you!