Amrita Amore Intake Step 1 of 4 - Confirm Your Info 25% We gather this information to make sure that we prepare for your attendance at class, and for our records. Please re-enter your name and email address to confirm your intake to the class.Name* First Last Email* Will you need to purchase a yoni egg?*Will you need to purchase a yoni egg?YesNo Age Group*Age GroupUnder 1818-2425-3435-4445-5455+What is your income group?What is your income group?Under US$200/monthUS$201 – US$500/monthUS$501 – US$750/monthUS$751 – US$1,000/monthUS$1,001 – US$1,500/monthUS$1,501 – US$2,500/monthUS$5,001 – US$10,000/monthOver US$10,001/monthWould rather not sayWhat is your highest level of education?What is your highest level of education?High SchoolAssociate DegreeBachelor's DegreeGraduate or Professional DegreeSome CollegeSkills CertificatePrefer Not to AnswerOccupation Do you use the Inter Uterine Device (IUD) for contraception?Do you use the Inter Uterine Device (IUD) for contraception?YesNoHave you had a hysterectomy?Have you had a hysterectomy?NoPartialCompleteHave you been diagnosed with any of the following?Have you been diagnosed with any of the following? No Uterine Fibroids Infertility Endometriosis Ovarian Cysts Ovarian/Cervical/Breast Cancer PCOS (Polycystic Ovary Syndrome) Uterine Prolapse Retroverted Uterus Incontinence Vaginal Dryness Pelvic Floor Disorder How did you hear about the Glowing Goddess Playshop?How did you hear about the Glowing Goddess Playshop? Facebook LinkedIn Instagram Twitter Newspaper Ad Referral from past participant Girlfriend's Expo Word of Mouth Google Search Orgasmik Intelligence Website Radio Where do you prefer to get your news?Where do you prefer to get your news?NewspaperOnline newsRadioSocial MediaWhat radio station/music service do you listen to?How would you prefer to learn about our products, services, educational/informational videos, specials, promotions, sensual tips etc?How would you prefer to learn about our products, services, educational/informational videos, specials, promotions, sensual tips etc? Newsletter Facebook Page Instagram Youtube Website Personal call Newspaper Ad Radio Ad I understand that I will have to pay the applicable fees before or upon arrivalI understand that I will have to pay the applicable fees before or upon arrival* Yes This iframe contains the logic required to handle Ajax powered Gravity Forms.