Name

First Name

Last Name

Twitter

Full Facebook Profile Link

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How long have you been meditating?

What is your biggest challenge when meditating?

On the average, how many times do you meditate a month?

How many people live in your house?

What keeps you from meditating consistently now?

What time do you typically wake up each day?

What time does the earliest person in your house wake up?