Clinic Registration - April 19, 2007

Coaching in the Workplace
Thursday, April 19th - 8:30 - 5:00
Alameda Public Library
1550 Oak Street
Alameda, CA 94501

First Name:
Last Name:
Title:
Company:
Address:
Address Line 2 :
City:
State:
Zip:
Phone:
Fax:
Email:
Please give your reasons for taking the clinic and your goals for the day:
Choose your registration: "Save me a Seat" for $50.00 (non-refundable deposit) "Early-bird" Registration for $450 -- No Longer Available Full Registration fee of $500 -- must be received by April 5, 2007
Select payment method: Debit or Credit Check or Money Order
As a Thank You gift, please select a Free Unit from Diane's Skill Kit for Success:

If paying by credit or debit, be sure to complete your registration in the next 2 screens.