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We guide people to identify and achieve their most awesome goals by providing a proven structure and processes that awaken desire, create direction, drive action, and sustain consistent application.   We facilitate success - for you and for the world.

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"People say that motivation doesn't last...Neither does bathing, that's why we recommend it daily." - Zig Ziglar

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Simply highlight the form and click on file / print.

Click the box for "selection".

Click on Print.

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 

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Amount to be charged: $_______________

Fax: 717-228-2302  

Mail:  1427 North 7th Street Lebanon Pennsylvania 17046-4307

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Copyright © 2005 Miller Institute
Last modified: 08/18/06