The Mentor-Coaching Institute: Expression of Interest Form

Expression of Interest

For more information please contact professionalservices@pearsoncanada.com

Contact Information

First Name *This question is required.

Last Name *This question is required.

Title *This question is required.

School Board/District *This question is required.

Street Address

Apt/Suite/Office

City

Province

Postal Code

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required.

OPC Member? *This question is required.

Number of Participants (minimum 15, maximum 35) *This question is required. This question requires a valid number format.

Participant Names and Email Address (Optional)

Preferred Dates - the Institute takes place over 4 days.
Session 1 (2 days) *This question is required. This question requires a valid date format of MM/DD/YYYY.

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1. Preferred Date: Session 2 (1 day)
(normally approx 6 weeks after Session 1) This question requires a valid date format of MM/DD/YYYY.

calendar

2. Preferred Date Session 3 (1 day)
(normally approx 4-6 weeks after Session 2) This question requires a valid date format of MM/DD/YYYY.

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Proposed Location *This question is required.

Preferred Invoicing Options *This question is required.

Credit Card
Purchase Order
Cheque
Other - Write In Please enter an 'other' value for this selection.

How did you learn about this course? (Optional)