Name :
Mailing Address :
City, State & Zip :
Phone :
Email :
How did you hear about this course? :
Referral from someone I know
Caroll told me directly
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Other
If you answered the question above with "Referral from someone I know," please list his/her name here:
Date of the course you are registering for:
Wednesdays beginning March 11, 2009
What specific, measurable result you would like to create out of this class? (It must be ONE specific thing, so you will know that you either got it or you didn’t. Ex: A specific amount of money, a new car, a new relationship, a new job, etc. It should be a “stretch” goal, i.e. not likely to happen anyway – but not impossible to believe!)
By the end of the Practical Prosperity course, I intend to create :