R E S P O N S E F O R M

PLEASE PRINT LEGIBLY: PROGRAM:Name: Company:Date: Years Experience:

Email Address: Telephone No.:

Challenge 1:

Challenge 2:

What was the business impact of this item? How much in lost referral revenue did each of the above cost you last year, or could they cost you this year?

Cost $ Business impact

Commitment to solve:

1 2 3 4 5 6 7 8 9 10

No TI0 Yes

Please email a copy of the Continuous Mutual Disclosure System Letters

Complimentary 15 minute Disclosure Session with Paul Tindall

Select a day:

Monday Thursday

Tuesday Friday

Wednesday

AND a time:

10:00 a.m. 12:00 p.m. 3:00 p.m.

2 Hour Business Evaluation Coaching Session (includes 2 detailed business development

assessments and recommendations) $495.00 + GSTo Core Competency Benchmarkingo Coachabilityo Communication Styleo Conservative Revenue Increase

LESSONS LEARNED

What have I learned? How will I use this lesson?1.

2.

3.