REGISTRATION FORM
Group Information
Group Name: __________________________________ Exp. # Participants: ________ Date: __________
Please explain the background and structure of your group. How long the group has been together. How well they know each other. Etc.
Contact Information – Chairperson
Name: __________________________________________ Phone #: ______________
Title: ___________________________________________ Alt. Phone #:___________
Address: ________________________________________ Fax: _________________
City, State, Zip: ___________________________________ Email: ________________
Program Information
Program Date: (first choice) ___________________ (second choice) ________________
Beginning Time: ____________ □ a.m. □ p.m. End Time: ____________ □ a.m. □ p.m.
Location: ____________________________ -address:_____________________________
Are you interested in meeting with TeamSmart to discuss possible program themes and agendas?
Yes / No If yes, TeamSmart will contact you to set up an appointment.
Goals and Objectives. TeamSmart can focus on many program themes. List those specific things you wish to accomplish during your program. The program agenda will be customized to these goals.
Please explain any special request or other information we should know.
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TeamSmart use only. Date Received ___________ SA ____________ Dep. ____________ IP ____________ Ag. ____________ |