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DSA Group Membership Application Questionnaire

Group Representative Name*

Phone number:*

Email Address*

Notification Preference*

Name of Business / Organization*

Group Category*

Number of years in Practice (for clients)*

Challenges or Problems you were able to overcome through your practice

Other Challenges or Problems you have overcome

Challenges or Problems of your clients you've helped to overcome

Other Challenges or Problems of your clients you've helped overcome

Gift Ticket Specification: Name (< 30 characters) and $ value*

Gift Ticket Specification: Description in terms of quantity and quality of product or service deals/package you offer - It should include lead time for the delivery of product or service, gift ticket validity period, and redemption location*

I declare under penalty of perjury that the foregoing is true and correct.

Executed on (date)*

Thank you for completing your DSA Membership Application Form. We look forward to supporting you in exchanging your gifts and meeting your needs & desires! Namaste, Divine Spark Allies

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