Who

Your Name *

Your Name

First Name

Last Name

Email Address *

Name of Organization *

Names of Other Important Contacts

Who will be Involved in the Group Coaching Experience?

Role and Number of People

What is the Purpose of the Group Coaching Experience?

What is the Mission of Your Organization?

What

What are you hoping to have change as a result of this experience?

How does this group coaching experience align with and support your organizations Mission?

When

When would you like to have the experience?

Approximate month and year at a minimum.

YYYY

Approximate Time and Duration

Where

How would you like to experience this session?

In Person

Virtually

Space Type *

If Other, Please Specify

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Value

I charge $120 per hour for my time on-sight. I am available to provide coaching on line. If travel is required I also charge hourly for the amount of time it takes me to travel from my Yarmouth ME to your location.