Registration forms must be received no later than 3 weeks prior to program date.

YOUR INFORMATION

Name:

Company:

Address:

Job Title :

City:

Phone #:

State:

E-Mail:

Zip:

Country:

Assistant's Name:

Work Phone #:

E-Mail:

How did you hear about us?

2010 OPEN ENROLLMENT DATES (LED BY A CERTIFIED PERFORMANCE COACH):

Investment:

$4,000.00

January 11-13, 2010
February 8-10, 2010
March 8-10, 2010
April 12-14, 2010
May 3-5, 2010
June 7-9, 2010
July 19-21, 2010
August 9-11, 2010
September 13-15, 2010
October 4-6, 2010
November 8-10, 2010
December 6-8, 2010

2010 OPEN ENROLLMENT DATES (LED BY DR. JIM LOEHR OR DR. JACK GROPPEL):

Investment:

$5,500.00

January 25-27, 2010
March 22-24, 2010
May 17-19, 2010
June 21-23, 2010
September 20-22, 2010
October 25-27, 2010
November 15-17, 2010

2010 OPEN ENROLLMENT DATES AT THE CLAREMONT HOTEL (IN SAN FRANCISCO):

Investment:

$4,000.00

March 22-24, 2010
April 7th-9th, 2010
June 14th-16th, 2010
August 2nd-4th, 2010
September 27th-29th, 2010
October 18th-20th, 2010
November 3rd-5th, 2010
December 13th-15th, 2010

2010 CHICAGO OPEN ENROLLMENT DATES (HELD AT THE Q CENTER):

Investment:

$4,000.00

April 19-21, 2010
July 12-14, 2010

DIRECT CONTACT TO:

Name:

Phone#:

A representative will contact you for payment information. Please provide preferred contact name and phone number.

Cancellation Policy: Individuals who cancel four or more weeks prior to the program will receive a refund minus a $500 cancellation fee. Cancellations less than four weeks prior to the program will result in a forfeiture of 50% of course fee. If rescheduling is done more than four weeks prior to the program, there is no rescheduling fee. Rescheduling less than four weeks prior to program will incur a $500 fee.Rescheduled course must be completed within six months of originally scheduled program date.

9757 Lake Nona Road

Orlando, FL 32827

407.438.9911

info@energyforperformance.com