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].