Parallax — NINIFIVEDESIGN

QUESTIONNAIRE

Please fill out the form based on who the necklace is for.

STARTER VERSION:

Name

First Name

Last Name

Birthday

MM

DD

YYYY

If there was a quality you feel you "work" to embody, what is it? Something that doesn't come naturally, but that you strive for, a word/quality/feeling:

Email (if this is a gift, please put your address)

FULL VERSION:

Name

First Name

Last Name

Birthday

MM

DD

YYYY

Your wife/husband/partner/children/family names and birthdays:

Anyone else who's most meaningful that you keep close to your heart everyday:

Any specific dates/occasions in your life that you choose to remember, that you hold especially dear (i.e. wedding date):

What motivates you:

What are you drawn to:

What lights you up in life/what feeds your soul:

Any spiritual/religious traditions you hold dear:

If there was a quality you feel you "work" to embody, what is it? Something that doesn't come naturally, but that you strive for, a word/quality/feeling:

Any specific symbols out there that ring true for you:

Any information you can provide is great, favorite color, animal, flower, hobbies, anything:

Email (if this is a gift, please put your address)