Step 1: Submission of the Pre-Registration Form: **(For Public Courses Only)
* Required fields
Firstly	Yes, I require a telephone Interview -or- I prefer my Application be directly submitted to the Institute's Selection Panel
Secondly, How did you hear about us?	a) Internet Search: I used Google, Yahoo, other b) Refferal: (past graduate, colleague, etc.) c) Other: (book, ad, etc.)
Thirdly	Have you read the book: 'Behavioral Coaching -How to build sustainable personal and organizational strength' (Publisher; McGraw-Hill, New York)? Yes, I have read the book! No, not yet. I will be ordering the text upon completing this form
Fourthly, Choose a tuition rate	Corporate Tuition Rate ($5,450) Private Tuition Rate ($4,850)
	Corporate Tuition Rates: are applicable when an individual's business/employer pays his/her course fee. Private Tuition Rates: are applicable to those individuals who pay for the course themselves.
Your Contact Information
Company Name:*
Contact Name:*	Mr. Ms. Dr.
Address:*
City:*
State, Zip:	,
Country:
Home Phone:
Business Phone*:
Cell Phone*:
Email Address*:
Re-enter Email Address*:
Business Email Address:
Web Site:
Your Profile
Occupation*:	, years in Vocation:
Type of Business:
Size of Business:	people
I am looking to use Coaching:	Internally (inside my organization). Externally (in a practice)Other:
Professional / Educational Background:
Your experience in People Development / Workplace Coaching (including number of years):
How can the very advanced Knowledge & Skills obtained from this Course assist you?
What are some of your primary Course Objectives?
Are you looking to specialize in a specific niche coaching area?
Other:
References (Business or Personal):	Yes (Fill in box below)
	Name / Contact Details:
Referral by CMC Graduate:
Select Course Location and Date
Preffered:	09/25 - 09/28/2008 - Los Angeles, CA 11/13 - 11/16/2008 - New York, NY 12/01 - 12/04/2008 - New York, NY
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