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Retainer Enrollment

First and Last Name:

Position:

Organization:

Street Address:

City:

State or Province:

Zip or Postal Code:

Country (if outside the US, Canada or the UK):

Telephone (please include country code if outside the US or Canada):

Fax:

Please provide the name of an alternate billing contact:

The alternate contact\'s telephone:

The alternate contact\'s fax:

Alternate contact\'s e-mail address:

Anticipated Payment Method:

Would you like to be e-mailed a monthly statement? Yes, please Don\'t clog my inbox, thanks

How do you expect to be using most of the retainer? (Check as many as apply) Media preparation Presentation training Narrative and message development Remote training (all types) Pricing communications training Crisis communications training Other consulting services

Would you like materials explaining your fee structure under the retainer?

Any other comments or suggestions?

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