David Chinsky & Associates - The Institute for Leadership Fitness TM

The Institute for Leadership Fitness TM - Clarity, Confidence, Effectiveness, Vitality

Download the enrollment form or complete the online form and call with your credit card number:

Enrollment Form (59 KB, PDF)

Full Name

Organization Name

Mailing Address

City

State/Province

Postal/Zip Code

Country

Business Phone

Fax

E-mail Address

Title

Years in Leadership Position(s)

Who influenced your decision to register for this Program?

Please indicate any specific dietary needs:

¬ Hold down your CTRL key and click to select multiple needs.

Please specify dietary needs if checked above:

Series Name

Date of First Session

I hereby authorize David Chinsky & Associates, LLC to charge my credit card number in the amount of $500 to hold my seat in the above program.

Name (will be interpreted as your signature)

Yes, I (please initial) authorize David Chinsky & Associates to charge the balance ($3,250) three weeks prior to the start date using my credit card.

By entering your name below, I certify that I have read and agree to all of the attached terms and conditions, and I also agree that:

my deposit is non-refundable
the balance of my Program fee is due three (3) weeks prior to the date of the first session noted above; and
once I attend the first session none of the Program fee is refundable or transferable, and there is no credit for missed sessions

Name (will be interpreted as your signature)



	Click here for your free downloadable copy of our special report called The Four Dynamic Qualities of Leadership Fitness™.