Neuro-Complex Creative Leadership Cohort Waitlist

Thanks for your interest. Please fill out and submit the form below to be added the waitlist for the next cohort. The information helps me better serve you.

Name

First Name

Last Name

Email

Address

This information is used to help with scheduling cohorts...time zones are a thing.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

When did you discover your neurotype?

Are you formally diagnosed or self identified?

Formally Diagnosed

Self Identified

What are your most pressing struggles or pain points?

Please list no more than 3 pain points.

What do you hope to gain from this cohort?

Please provide a brief description of your occupation or area of purpose.

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Would you like to receive newsletters with useful tidbits and updates from Lawrence Kampf (Lawrence Kampf is a dba of Nova Earth Institute)?

Yes, please send me newsletter updates from Lawrence Kampf.