Retreat Registration

Registration for Neuroleadership Retreat

Powerful Leader Retreat

November 5, 2009
Norbertine Hermitage
Albuquerque, New Mexico
8:00AM to 5:00PM
with Suzanne Kryder, Ph.D.

Thank you for your interest in this retreat.

Repeater Discount

Have you attended a public leadership retreat with Suzanne in the past? If you refer a colleague or friend who registers for the Powerful Leader Retreat, you will receive a 50% discount on your fee for the same retreat. After your colleague registers, contact Suzanne for a link to the Repeater registration page.

Registration

To register, you can either (1) complete the online form below and submit it by clicking the "Submit" button at the bottom of the page, or (2) you can print the form below, fill it in, and mail it to the Mind to Lead.

If you would prefer to submit your credit card number by phone, complete the online form below, and check "Call me for credit card information."

If you're paying by check, your registration will be complete and a space will be held for you when we receive your check by mail. Make check payable to: "Suzanne Kryder, Inc."

Mail:
Suzanne Kryder, Inc.
P.O. Box 35429
Albuquerque, NM 87176

Registration Form

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Re-enter E-mail address*
Re-enter E-mail address*

Business Phone*
Business Phone*

Title*
Title*

Organization Name*
Organization Name*

Billing Address*
Billing Address*

Billing City*
Billing City*

Billing State*
Billing State*

Billing Zip*
Billing Zip*

Lunch Choice*
Lunch Choice*

	Turkey and Cheese
	Ham and Cheese
	Cheese, Avocado and Tomato
	No lunch

Registration Type*
Registration Type*

Retreat: $279.00 + $19.18 tax = $298.18

Payment method (check one)*
Payment method (check one)*

	VISA
	MasterCard
	Discover
	American Express
	Call me for credit card information
	Check payable to "Suzanne Kryder, Inc."
	Purchase Order

Credit Card Number

Card Expiration Date

Signature for credit card (for mailed registration)

Comments or special request

By completing this form and submitting your credit card number, you agree that Suzanne Kryder, Inc. will charge the stated amount to your card.

If you have any questions about the retreat or the registration process, contact the Mind to Lead.

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Upcoming Events

March 10 - Mindfulness at Work: Benefit Workshop for New York Insight Meditation Center, New York, NY

March 14 - Neuroleadership Development: A Brain-based Approach to Organizational Success: Free Webinar from the Chesapeake Bay Organization Development Network

March 21 - The Neuroscience of Networking: Practical Tools for Calm, Confident Connecting: Washington Network Group, Arlington, VA

May 1 - Adv. Leadership Workshop: George Washington University's Center for Excellence in Public Leadership, Washington, DC