STRENGTHS-BASED COACHING® Registration

STRENGTHS-BASED COACHING®
FOR TECHNICAL ASSISTANCE PROFESSIONALS AND OTHER LEADERS
April 16-17, 2015 (Two full days of training) 9:00 am - 4:30 pm
at Francis Institute for Child and Youth Development, Kansas City, Missouri
Registration Form - DUE March 26, 2015
PLEASE PRINT THE FOLLOWING INFORMATION
First Name: _______________________________MI:____Last Name:________________________________
Organization Name: ______________________________
Position Title:__________________________
Address: ________________________________________________________
Home Business
City: __________________________________________
State: ________________ Zip: ______________
Work Phone & Ext.: __________________________________
Fax Number: ________________________
Cell Phone (only used to contact you in emergency while in Kansas City):_____________________________
Email Address: __________________________________________________________________________
(Important! Your Registration confirmation will be emailed to you.)
Check here if you have special needs or dietary needs. Please specify: _______________________
How did you learn about Strengths-Based Coaching ® training?
 Conference booth at ___________________  Workshop session at ____________________
 Conference program brochure from ________________  Recommendations from colleagues
 www.AskFrancis.org website  Other ______________________________________________
Training Fee: $190.00 (includes workbook and lunch for two days)
Fees must be paid in US funds drawn on a US bank or bank draft
Method of Payment:  Check  Money Order Make checks payable to MCC-Penn Valley.
Mail registration form and payment to:
Joy Humbarger
Francis Institute for Child and Youth Development
3201 Southwest Trafficway
Kansas City, MO 64111
PAYMENT MUST ACCOMPANY REGISTRATION FORM.
Upon receipt of your completed form and payment information, a detailed confirmation email will be sent.
For registration questions, please contact Francis Institute at 866-676-6224 or 816-604-4347, or email
[email protected].
CANCELLATION POLICY
4 Registrations cancelled after March 26, 2015 are subject to the full fee.
4 Cancellations prior to March 26, 2015, will incur a $50 processing charge. Telephone cancellation
is not accepted; certified mail is recommended. Send cancellation request by March 26 to Joy
Humbarger, Francis Institute for Child and Youth Development, 3201 Southwest Trafficway, Kansas
City, MO 64111 or [email protected].