Workshop Name:
Choose one
The Discovery Workshop
The Breakthrough Course
The Leadership Program
The Journey (Discovery, Breakthrough and LP)
The Discovery and Breakthrough
The Breakthrough and Leadership
Personal Coaching
Train the Trainer
The Abundance & Prosperity Workshop
Workshop Price:
Choose one
The Discovery $395
The Breakthrough $995 (Tonight only)
The Discovery and Breakthrough $1295
The Breakthrough and LP $1895
The Leadership Program $895
The Journey (Discovery, Breakthrough and LP) $2095
Personal Coaching (2 months - twice weekly) $1000
The Abundance & Prosperity Workshop $250.00
Train the Trainer PIF ($4500)
Train the Trainer Dep ($1500) Total price $5000 with 3 payments
for office use only
First Name:
Last Name:
Nickname (preferred name):
Mailing Address (Only fill out if different than billing address)
Address 1:
City:
Address 2:
State:
Zip Code:
Phone Numbers
Home:
Best time to call:
8:00am
9:00am
10:00am
11:00am
12:00pm
1:00pm
2:00pm
3:00pm
4:00pm
5:00pm
After 5:00pm
Work :
Best time to call:
8:00am
9:00am
10:00am
11:00am
12:00pm
1:00pm
2:00pm
3:00pm
4:00pm
5:00pm
After 5:00pm
# of Children:
Ages (ie: 3, 5, 12):
Referred to this workshop by:
Occupation:
Birth Date:
Please list three things you would like to accomplish by participating in this workshop:
Pricing & Refund Policy Statement
I have read, and agree to, the Pricing & Policy Statement above.
