Answer the following questions from the Personal Empowerment Institute Snapshot Test to receive a FREE summary. (These are the type of questions and issues that we confront in our Presentations and Workshops.)

The answers will be emailed to one of the Personal Empowerment Institute Facilitators who will be able to answer any questions you may have, and help you begin the journey to harness the power within you and share your unique gift with the world.

	PERSONAL DETAILS
	Name:	*
	Email:	*
	Phone:	*
	Postcode:	*
		I would like to receive periodic information from the Personal Empowerment Institute. Yes No

	QUESTIONS	ANSWER
1	Is there anything you are afraid of admitting?	Yes No
2	Do you have difficulty in relationships?	Yes No
3	Are you generally controlling with people you love?	Yes No
4	Is there anybody you have not forgiven?	Yes No
5	Do you have trouble knowing what you want?	Yes No
6	In relationships do you share 100% of yourself with your partner?	Yes No
7	Do you try to control your feelings most of the time?	Yes No
8	Do you find yourself in frequent conflicts with people in authority?	Yes No
9	Do you avoid conflict?	Yes No
10	Do you feel guilty when you say no to someone?	Yes No
11	Do you have trouble identifying what you are feeling at any given moment?	Yes No
12	Do you sometimes feel that what you do is not good enough?	Yes No
13	Do you believe you are responsible for other peoples feelings?	Yes No
14	Is there any action you might be avoiding right now, that would change your life's destiny?	Yes No
15	Would you do anything different if you knew you could not fail?	Yes No
16	Is there anything you would regret in your life if you did not do it, if you knew your life was ending?	Yes No
17	If you had a week left to live would you spend it with the people you are with now?	Yes No
18	Do you know what you want, to live a fulfilled life?	Yes No
19	Do you find yourself giving other people advise, that you yourself do not do?	Yes No
20	Do you know your purpose in life?	Yes No