How to Coach Yourself and Others Essential Knowledge For Coaching | Page 605

___ Website
___ A friend told me - Please specify who*: _______________________
___ A Workshop
___ SNAP
___ Other:

__________________________

* Those who refer coachees to Forest Cottage receive an Affiliate Award.
They will not be told your name.
* Notes: Please indicate any further information you wish the coach to
know on reverse.
Billing Information
I prefer to pay by:
* Cheque (Made Payable to: Forest Cottage Centre) - Must be received
prior to first session of each month.
* Visa MasterCard
Name on Card: ______________________
Billing Address (if different from mailing address):
________________________________________________________
Card Number: _______________________________________ Exp ____ / ____
I authorize (please check one) $80.25 ($75.00+GST) CDN per hour OR
$___________ CDN per month to be automatically billed prior to my first
session of each month. I understand that payments will continue as per
my contract for a minimum of 3 months and then monthly unless 14
days cancellation notice is given prior to the billing date.
Signed: ___________________________________________

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