1. R E S P O N S E F O R M
PLEASE PRINT LEGIBLY: PROGRAM:
Name: Company:
Date: Years Experience:
Email Address: Telephone No.:
Challenge 1:
Challenge 2:
What was the business impact of this item? How much in lost referral revenue did each of the above cost
you last year, or could they cost you this year?
Cost $ Business impact
Commitment to solve:
1 2 3 4 5 6 7 8 9 10
No TI0 Yes
 Please email a copy of the Continuous Mutual Disclosure System Letters
 Complimentary 15 minute Disclosure Session with Paul Tindall
Select a day:
 Monday  Thursday
 Tuesday  Friday
 Wednesday
AND a time:
 10:00 a.m.  12:00 p.m.  3:00 p.m.
 2 Hour Business Evaluation Coaching Session (includes 2 detailed business development
assessments and recommendations) $495.00 + GST
o Core Competency Benchmarking
o Coachability
o Communication Style
o Conservative Revenue Increase
LESSONS LEARNED
What have I learned? How will I use this lesson?
1.
2.
3.