DSG AFFILIATION PROPOSAL

Please Fill Out as Completely as Possible:

Your Name:
Your Name as It Should Appear in Your Listing:

Your Institute or Organization:

Your Mailing Address:
Street:
Apt. or Suite:
City:
State/Province:
Postal Code:
Country:

Your Professional Contact Email Address:
Your Professional Contact Telephone Number:
Your Professional Website:

Program Information

For which PROGRAM are you interested in being AFFILIATED?

SFM I: Next Generation Entrepreneur

SFM II: Collective Intelligence

SFM III: Conscious Leadership and Resilience

Please specify the START and END DATE for each SESSION or MODULE in the Program you are Proposing. The sessions must add up to a MINIMUM of 8 FULL DAYS.

Enter Dates in "MONTH/DAY/YEAR" Format.

Session Number	Start Date	End Date	Number of Days
1.
2.
3.
4.
5.
6.
7.
8.

Let us know the LOCATION where the program will take place.

Program Address:
Street:
Apt. or Suite:
City:
State/Province:
Postal Code:
Country:

How many PARTICIPANTS do you expect to have in your program?

How many RESOURCE PEOPLE?

How will you ADVERTISE the program?

Internet

Individual mailers (postcards brochures, etc.)

Announcements in other advertising (please specify)

Will there be there OTHER TRAINERS in your program? If so, who are they and what are their training backgrounds?

I confirm that the above information is correct to the best of my knowledge.

Date:

Click here to when done.

Thank you! We will respond to your proposal as soon as possible.
If you have any questions, write to us at:
DiltsStrategyGroup@gmail.com