Center Stage Group

Power Camp Dates Requested*
Name*
Phone*
Email Address*
Company*
Role or Title*
Responsibility*
Direct Manager*
Business Unit or Department*
What is your biggest challenge in your current role*
How did you hear about Power Camp and what is your motivation for attending? Please be specific with any names, so we may thank them for referring you.*
Would you like a massage? ($100 plus tip payable to Jenna Joyce. Cash or check.)	Yes
Would you like a session with our hypnotherapist? ($100 plus tip payable to Betty Nelson. Cash or check.)	Yes
Any comments or questions? Once you click on Submit you will directed to our online payment system. If you prefer to complete your transaction via the phone, please call us at 408-269-4436. Thank you! We look forward to working with you. Once you have registered, you must pay for the training in order to guarantee your spot.


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