Contact Person Name/ Title

Name of Organization

Phone

Fax

Email Address

How did you hear about Forward Push Empowerment? How did you hear about Forward Push Empowerment?AdvertisementFormer Forward Push ParticipantFlyerInstagramPersonal InvitationEmail

How many participants are you expecting?

Will your facility accommodate your expected number of paricipants? Will your facility accommodate your expected number of paricipants? yes no

What age range of individuals do you anticipate will attend?

What kind of event are you interested in hosting? What kind of event are you interested in hosting? Saturday all day Push Workshop (10 am-3 pm) Friday evening Push Speaking Engagement Some other day or time? Please describe

Describe

PARTICIPANT DEVELOPMENT

1. What are some of the biggest challenges that the participants are facing?

2. One area you believe is the most need? (e.g., spiritual, financial, emotional, social, or physical)?

3. What one thing would make the event a success? (e.g., better team work, greater commitment, increased buy-in to vision/mission)?

STAFF DEVELOPMENT

Are you interested in personalized Forward Push Empowerment Coaching for specific team members to help Forward Push others? Are you interested in personalized Forward Push Empowerment Coaching for specific team members to help Forward Push others? yes no I need more information

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