Voice: 732-845-1960
Fax: 732-845-1961
LSPA North
Positive
Impact Associates, Inc.
Richard
Reale
201-573-0027
Name_______________________________________ Title
_________________________
Address
______________________________________________________________
Phone _______________________________________ Email
___________________
Organization
___________________________________ Fax ____________________
I am interested in receiving more information about:
Individual Retreat & Renewal for: myself my organization team retreat.
o
After hours: evening and ½ day
o
Full day - customized
o
Two full days - customized
Hosting a Leadership Retreat & Renewal
offsite or at the Leadership Alignment Spa LLC.
Hosting an Executive Preview at my worksite
I would like to visit the Leadership
Alignment Spa at 83 South St. Freehold, NJ for an Executive Preview.
Please include me on the email newsletter and
listing of events taking place at the Leadership Alignment Spa.
Please list below any other points of interest or questions
you would like to discuss:
______________________________________________________________________________
______________________________________________________________________________
Name of Cardholder:
________________________________________________________________________
Visa/Mastercard:
Card no.
_______________________________ Exp.
Date: _________________________
Checks payable to JWH Training and Consulting, Inc.