My Wish The Movie - Funding/Coaching Registration

THE BELOW INFORMATION NEEDS TO BE FILLED OUT IN ORDER TO PLACE YOUR NAME IN THE FILM AND TO HAVE YOUR COACH CONTACT YOU SO THAT YOU CAN START LIVING YOUR DREAM ! (Your email will be used for that purpose only.)

Full Name:
City:
State:
Email:

How would you like your Name/Business to be written in the movie:

I would like to concontribute $100.00 toward the making of "My Wish" the movie , have my name / business be in the ending credits AND participate in a complementary "MY Wish" discussion with a certified "Dream Coach" !
I'd like to be part of the "My Wish" Funding/Coaching Experience and want to contribute beyond the $100.00!
I'm not able to be part of the "My Wish" Funding/Coaching Experience at this time, but would still like to contribute a smaller amount to the movie!

Total Contribution:

- I know someone who has the ability to take this funding concept to large audiences to get them involved in helping out the movie and themselves in pursuing their dreams!

If so, please tell me more about it.

"My Wish" is to:
What's your dream?

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