Download the enrollment form or complete the online form and call with your credit card number:
Enrollment Form
(512 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:
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Hold down your CTRL key and click to select multiple needs.
Vegetarian
Allergies
Other
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 $750 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 ($4,000) 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)
Program Overview
(483KB PDF)
How the Program is Delivered
(520KB PDF)
Upcoming Dates & Locations
Enrollment Form
Click here
for your
free
downloadable copy of our special report called
The Four Dynamic Qualities of Leadership Fitness
™.
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