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ChoiceCenter Worldwide
Personal Effectiveness & Leadership Trainings

I. Personal Information

Date of Course:
Best Phone #:
Best time to call me:

Last Name:
First Name:
Address:
City
State::
Zip Code:
Birthdate:
Occupation:
Employer:
Home Phone:
Cellular:
Fax:
Work Phone:
Other Phone:
Email address:
   

II. Who Referred You?

Name:
Their email address:
Their home #:
Their cell #:

 

III. Personal Objectives:
Indicate in very specific terms the results that you want to achieve through your participation in this training :

Objective #1:
Objective #2:
Objective #3:

 

IV. Training

Check one:
 Tuition: Personal Effectiveness Trainings 1 & 2 PLUS The Leadership Program= $2499.
  Option: Personal Effectiveness Part 1 and Part 2 = $1599.
        ( Pre-payment options: $845 for part 1 ; $945 for Part 2 )
  The Leadership Development Program = ........................................................$1299.

 

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