Pike Ascent Registration Form

PRIORITY ACCEPTANCE FORM

Yes! I'm ready to become a NEW CHANGE AGENT so sign me up for the September Pike Ascent in Minneapolis!

PRIORITY ACCEPTANCE FORM for PIKE'S ASCENT
(Please Submit One Registration For Each Person Attending)

Name		Job Title
Company	Address	City, State, Zip Code
Phone	Fax	E-mail Address

THE PIKE ASCENT AND PRE-ASCENT REGISTRATION		TOTAL
The Pike Ascent Registration (Included the reception on Tuesday night) - Discounts are applied lower in the form.	$1,995	$
Yes, I want to be personally coached by Bob Pike. I wish to enroll in the "Inner Circle Coaching Program," which begins with a private dinner at the event and runs for six months. I will receive a personalized session attendance plan, six months of coaching via email, monthly Q&A webinars, and a one-hour private phone consultation. (This special package is limited to 50 participants)	$1,295	$
Register to attend Ascent Session #212 Extreme PowerPoint Makeover	$0	$

PRE-ASCENT 3-DAY WORKSHOPS SEPT. 28-30	With Conference Registration	Without Conference Registration	TOTAL
Presentation Skills for Trainers and Subject Matter Experts	$1,295	$1,495	$
Instructional Design for Participant-Centered Training	$1,595	$1,795	$
PRE-ASCENT 2-DAY WORKSHOPS SEPT. 29-30	With Conference Registration	Without Conference Registration	TOTAL
Train-the-Trainer Boot Camp	$1,095	$1,295	$
Getting Started with e-Learning	$1,295	$1,495	$
PRE-ASCENT 1-DAY WORKSHOPS SEPT. 29	With Conference Registration	Without Conference Registration	TOTAL
Coaching with Confidence	$645	$695	$
Project Management	$645	$695	$
PRE-ASCENT 1-DAY WORKSHOPS SEPT. 30	With Conference Registration	Without Conference Registration	TOTAL
Storytelling	$645	$695	$
The Coach Approach to Building Trust and Giving Feedback	$645	$695	$
Special Workshop for Educators Only Designing Lessons that Score: A Learner-Centered Model for ALL Educators	$249	$249	$

THE PIKE ASCENT DISCOUNTS: You may qualify for multiple discounts—enter all that apply!		TOTAL
EARLY REGISTRATION: $900 if paid before June 1, $300 if paid before June 15, $100 if paid before July 27 (ONLY VALID FOR PIKE ASCENT REGISTRATIONS, NOT FOR PRE-ASCENT WORKSHOPS)		$
THE BOB PIKE GROUP CERTIFICATE PROGRAM GRADUATE DISCOUNT: $50 (subject to verification) Please Select the Certificate Program that you have completed:		$

TOTALS
PRE-ASCENT TOTAL	$
PIKE ASCENT TOTAL	$
THE BOB PIKE GROUP CERTIFICATE PROGRAM TOTAL	$
DISCOUNT TOTAL	$
TOTAL	$

I understand that as a participant in the Pike Ascent I will receive, as a Special Bonus, a guaranteed pre-reservation and a 50% discount to the Three-Day 2009 Pike Ascent Transformational Climb Event.

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Payment Method (All Payments Must Be in U.S. Funds)

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