Your Name
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Do you have children?
YesNo
If yes for above, have you ever existed a Heguru?
If yes for above, which Heguru centre in which country?
E-mail
Confirmation of Email
Telephone number
Current occupation
Sector of current business
Name of Corporation/Company where you belong (mainly)
Your current residence
Location for launching Heguru (City, State, etc.)
Launch month / year
Approximate budget for the launch
Business partners, if any
Why Heguru?
Message
I have confirmed the information above.
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