Please provide the following contact information:

Name:
Daytime Phone:
E-mail:

How did you first find out about NLP?

Through a friend or acquaintance
Book
Magazine article
Website
Other

Which applications of NLP are you mostly aware of?
(Select the one or two you are most familiar with)

General Personal Development
Therapy / Counselling
Coaching and Performance Management
Influencing (Sales and Negotiation)
Health
Other

Which Applications of NLP are you most interested in?
(The select the one or two you are most interested in)

General Personal Development
Therapy / Counselling
Coaching and Performance Management
Influencing (Sales and Negotiation)
Health
Other

Are you thinking of taking an NLP training in...

1-3 months
3-6 months?
6-12 months?
1-2 years?
Never?

What level of training are you interested in?

Introductory (1-3 days)
Diploma / Certificate (3-7 days)
Practitioner
Master Practitioner
Trainer
Application Specific - Coaching
Application Specific - Health
Application Specific - Therapy / Counselling
Application Specific - Influencing / Presenting
Other

What is the most important area for your own personal development right now?
(Optional Question but we do like to know what people's most pressing concerns are so we can focus our services on what is most needed)

Do you have any other comments you would like to make regarding your first experience with NLP, its applications or choosing a training provider?
(Optional Question but we appreciate any additional comments)