Your Internal GPS

New Client Form for Organizations

Please complete this form, then read and indicate your agreement to the terms that follow before clicking Continue.

*Company Name:

*Contact Name:

Title:

Company:

*Address 1:

Address 2:

*City, State, Zip:

*Telephone:

*Email:

* denotes required
information

To Reserve Dates

Randy Siegel will reserve dates once a deposit covering fifty-percent of the fees and the full airfare is received.

Cancellation and Rescheduling

This deposit is non refundable but can be applied to sessions conducted within three months. Rescheduling requests made less than ten working days before the program date may result in additional expense.

Payments and Terms

Invoices are e-mailed at the completion of the program. Please make out all checks to Randy Siegel. All invoices are due within thirty days. In the event that invoices are not paid on time, the unpaid balance will accrue interest at the rate of eighteen percent (18%) per annum.

I have read and agree to these terms.