Sponsor Affiliate Nurse And Grow Rich™ Program Basic Reply Data
We would like to consider sponsoring a Nurse and Grow Rich Program. We understand the requirements in general. Any additional questions if any that we have are attached; Our Basic information to get the ball rolling is as follows:
Contacts Name: ______________________________________________
Sponsor Organization/Affiliate____________________________________
Address____________________________________________________
City_____________________________State_______Zip_____________
Office Phone______________________Fax _______________________
Email____________________________
Agency Affiliate Type: ____Hospital ___Association ___Independent Contractor
Long Term Care Facility ___H H Agency ___University ___ School
___ Health Care organization ___ Other
Length of Program
We would like to have a program of the following length:___ 1/2 day (up to 3 hours)___ One full day___
Up to six hours presentation time____ a Key note address of _____________ of during a ___________.
Other Please Explain______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Desired Date and time________ Please give at least 3 dates and times, if possible as to your preference
Date(s) I________________ Time_____________
Date(s) II________________ Time_____________
Date(s) III________________ Time_____________
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Please Forward this completed form to: Dr. Gloria Jo Floyd. Fax: 210-698-8701 E-mail drgloriajofloyd@ncehs.com or call 210-698-8700.
© 1999-2011, Dr. Gloria "Jo" Floyd, NCEHS, 14439 N.W. MILITARY
HWY #108 PMB 615
SAN ANTONIO, TX 78231,O=210-698-8700, F=210-698-8701
[O] 210-698-8700, [F] 210-698-8701,
email:
info@ncehs.com;
www.ncehs.com;
or
www.DrGloriaJoFloyd.com
©2011 All
Rights Reserved
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