YES! I will attend this Workshop/Intensive: (check selections)
____Time PLUS
____Uncovering
Attitudes & Values
____Personal Behavior
& Communications
____Goal Planning &
Achievement
____Mastering Success Course
Preferred Attendance Date:
_________________________
Second Choice Attendance Date:
_____________________
Name
_____________________________________________________________
Address ____________________________________________________________
Email:
____________________________________________________________
Do
you prefer a paper-based assessment? Yes No
Payment o Check or Money
Order o MasterCard or
Visa
CC#
_______________________________________ Exp __________
Date_______________
Name on Card
________________________________________________________
Amount to be charged: $_______________
Fax: 717-228-2302
Mail: 1427 North 7th Street Lebanon Pennsylvania 17046-4307
Notes: