To receive a free 30 minute telephone consultation, please fill out the form below and “SUBMIT” it to me. Completing each section fully is helpful for expediting your request and thereby providing you with the maximum benefit in the time available. First Name Last Name Name by which you wish to be addressed Company Position Email Address Best days and times for phone contact How did you hear about us? Friend Client Web Search At one of our seminars Philadelphia Magazine What is your interest that you wish to pursue? What would you like to achieve from working with a coach? Congratulations for having the courage to step forward and say, “Yes, I want to move off dead center. Yes, I want a new life story. Yes, I am ready to look for it now.” Let’s move forward together with joy and confidence. Warrant: all interactions, written and verbal will be strictly confidential. At the end of the initial consultation, we will estimate the number of sessions that will be needed for your goal. Once agreed upon then the coaching program will be a commitment of time and resources.* Yes, I want to move off dead center and want a new life story. No, I want to stay where I am. I will respond with telephone contact arrangements normally within 48 hours. ____________________________  *The fee for each 50 minute session is $100.00 payable in advance by the month or at a discount if payment is made initially for the total number of sessions anticipated. Three sessions per month are held on the same day and at the same time each week. You will receive an e-mail confirmation of agreement, confidentiality and warrants along with a request for payment for services. The payment can be made via PayPal directly from this e-mail.