Interview Pre-Questionnaire

Robert Pagliarini, the #1 national bestselling author of The Six-Day Financial Makeover, is currently writing a book about what people should do during their free time in order to live a more fulfilled life and to take their financial life to a new level.

He is interviewing people from all walks of life that have a special story they'd like to share about how they have used their free time to start a successful business, achieve a physical feat they once thought impossible, learn a new skill, etc.

The biggest, boldest, and most inspiring stories will be included throughout the book to add flavor and a real-life human element to the book's message. If you are interested in participating in an interview, please complete the questionnaire below and someone will contact you.

Name:*

Address - Line 1:*
Email Address:*

Address - Line 2:
Phone Number:*

City:*

State:*

ZIP Code:*
Time Zone:*
Can you set aside an hour for an interview, and if so, what days/times are the best for your schedule?*
Please provide a brief summary of what you have done during your free time:*
How has what you have done during your free time made your life better?*
Are you willing to sign a release form that will allow the author to use your story and words in a book?*

Yes

No