The Leadership Circle 360 Feedback Tool Registration


	TLC PROFILE

	Introduction
	Benefits / Advantages
	Brochure
	Results Graphic
	Whole Picture
	Creative Competencies
	Reactive Tendencies
	Summary Dimensions
	Research

	PROFILE CERTIFICATION

Profile Certification Registration

Please fill out this on-line registration form and complete all questions. After you submit your registration, you will receive phone or e-mail acceptance into the certification program. Payment in full is then required in order to reserve your seat. You will be invoiced. Payment can be made by check, Visa, or MasterCard. We will also send you hotel reservation information and travel directions via e-mail.

Registration Fee . . . . $2,495 USD

ALL FIELDS REQUIRED

Date of Certification

Select a Date

Washington, DC– Gaithersburg, MD	2010-March	17, 18, 19	Wed-Fri
Chicago, IL	2010-May	3, 4, 5	Mon-Wed
Washington, DC– Gaithersburg, MD	2010-September	8, 9, 10	Wed-Fri
Chicago, IL	2010-November	3, 4, 5	Wed-Fri
San Diego, CA	2010-December	1, 2, 3	Wed-Fri

Contact Information

Name:

Email:

Position:

Company:

Street Address:

Street Address 2:

City/Town:

State or

Province / Territory:

Zip / Postal Code:

Country:

Phone:

Fax:

Have you previously completed TLC Profile within 12 months of training date?

Yes
No

Indicate your profession:

Please check all that apply
Coaching
Independent Consulting
Internal OD/HR/OE
Therapy
Other

Do you have executive coaching experience?
If yes, provide a brief description below.

Yes
No

How did you hear about The Leadership Circle?

Please check all that apply

Referred by:

Please enter ONE name.
I answered questions for a colleague's Profile
I have had a Profile done on myself
Internet search
TLC Brochure
TLC Direct Mail
Attended a TLCP presentation

Cancellation-Refund Policy
A $300 processing fee will be withheld for any cancellation. Cancellations made in writing more than 30 days prior to the start date of certification will receive a refund of $2195. If cancellation is made in writing less than 30 days prior to start date of certification, a credit of $1,000 can be applied to a future Profile Certification—listed on this webpage—held within twelve months of cancellation. Cancellations made without written notice, or a second cancellation, will result in no refund. TLC does not apply or transfer fees, refunds or credits towards any program other than those public programs listed by The Leadership Circle (by date and location) on this web page.

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You can also e-mail your questions to The Leadership Circle
or call us toll free at (800) 895-0399