On-Going Coaching Registration 2018-2019

*First Name
*Last Name
Address 1
*City
State
*Zip
*Phone
*Email
*District
Coach's Name
Coaching-Pay with Credit Card ($200)

I agree to pay $200 for 6 sessions of coaching. You have the option of paying by credit card when you submit this registration or mailing your check to: Great Plains Conference, Coaching, 1207 SW Executive Drive, Topeka, KS 66615

Pay with Check ($200)
*Attach your Feedback form here

Attach file pdf, doc(x), xls(x), jpg/gif/png, ppt - up to 25 MB

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