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Download and mail with fee to: Robert A. Gallagher 1417 Queen Anne Ave. N. #402; Seattle, WA 98109 REGISTRATION FOR CERTIFICATE PROGRAMS Please register me for: __ 1. The Consulting Certificate Program __ 2. The Leadership Program DATE: ___________ NAME: ________________________________________ ADDRESS: ___________________________________ ______________________________________________ E-MAIL: ________________________ [You must have e-mail with a capacity to receive Word attachments to participate in the program] WORK PHONE: _________________ HOME PHONE: _________________ FAX: _________________ ___ Attached is a fee of $800.00 made out to " Robert A. Gallagher" The fee covers staff consultations for feedback/assessment reviews, reviews of consultation & leadership projects, and program administration As of 8/02 |