YES! Please accept me:
____ June 23 & 24, 2005 - The Basic Field Trip '05 Package
I understand the cost for the Basic Field Trip '05 Package is $1999. All cancellations made within 30 days of the event are subject to a $200 cancellation fee.
Payment in full
____ I prefer to pay $1999 in full today. This fee includes tuition, program materials, lunch each day of the program and on-going e-mail conversations with the team leaders for one full year. Click here to make your payment in full. After completing payment, be sure to complete this form and fax to 1-215-699-3153.
Payment Plan:
Select one of the following payment plan options, complete the remainder of the form, and fax to 1-215-699-3153.
____ Click here to make your first payment today of $700 and 2 consecutive monthly payments of $700
After completing payment, be sure to complete this form and fax to 1-215-699-3153.
YES! Please accept me:
____ June 23 & 24, 2005 - The Deluxe Field Trip '05 Package
I understand the for cost for The Deluxe Field Trip "05 Package is $4995. All cancellations made within 30 days of the event are subject to a $200 cancellation fee.
Payment in full:
____ I prefer to pay $4995 in full today. I will receive a Pre-Field Trip’05 Phone Session with a team leader. This phone session is designed to help me articulate my intentions and expectations prior to Field Trip ‘05 so that I will arrive prepared, focused, and already thinking about what I want to do. This intentional pre-articulation will increases my learning over the two-days. Click
here to make your payment in full. After completing payment, be sure
to complete this form and fax to 1-215-699-3153.
Payment Plan:
Select one of the following payment plan options, complete the remainder of the form, and fax to 1-215-699-3153.
____ Click here to make your first payment today of $697 and 6 consecutive monthly payments of $759.
____ Click here to make your first payment today of $697 and 8 consecutive monthly payments of $607.
____ Click here to make your first payment today of $697 and 12 consecutive monthly payments of $421.
After completing payment, be sure to complete this form and fax to 1-215-699-3153.
On the line below list your coaching business information exactly as it appears on your website, brochure or business card (business name, address & phone #)
____ YES! Block out my 4 most annoying and threatening competitors from attending the 2005 Super Success Field Trip for Coaches, Consultants, and Small Business Owners. Please also block them off your mailings until I attend the 2-day seminar. Unless I ever decide to give up my spot in the mentoring membership (included for one year), they are to be blocked from attending.
List your 4 choices with coaches name, address,
phone # exactly as they appear on their website, business card or brochure.
1.______________________________________________________________________________________
2.______________________________________________________________________________________
3.______________________________________________________________________________________
4.______________________________________________________________________________________
Once my payment and fax is received, I will be notified by email of my confirmation
status within 3 business days. If I am blocked out, a credit will be issued
for the payment processed.
Send my advance seminar preparation manual to:
Name: __________________________________________________________________
Email: __________________________________________________________________
My contact info:
Address:________________________________________________________________
City/Town: _____________________________State:___________Zip:______________
Telephone: ______________________________Fax:____________________________
Non Disclosure Agreement- (must be completed)
I _______________________________________________ hereby agree that the material and information I will receive from successful coaching strategies, are for my own personal and coaching business use. I agree that I will not share any materials; alumni mastermind membership e-group, passwords, call, or concepts discussed at seminar with any coaching business that is not a member of our group, regardless of where they are located. I understand that violating this agreement will result in being disqualified from any future seminars and will result in immediate termination of any membership privileges.
Signed: _________________________________________Date: ________________________
Fax this completed form immediately to 1-215-699-3153 to complete your registration. Registration is accepted on a first come first served basis. Please call us toll free at 1-877-401-6165 with any questions.