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	The Memory Training Institute "Nothing in life changes until you change. When you change, everything changes."

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Please Call 1-800-524-5954 to inquire of any special pricing offered in your area.

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First Name:*
Last Name:*

Company Name:

* How would you prefer to be contacted?

Phone:

Email:*

	I would like to receive email regarding workshops in my area.

What does your company do?

How may we help you?

What are the most important kinds of information that your people need to remember on a daily basis (ex. scripts, names, products or services)?

Check off the areas of memory that are important to you and what you would like to learn (check all that apply):

	Remember names and faces

	Increase the long term memory retention of technical data

	Be able to do speeches and presentations without notes, cue cards and brochures

	Learn information faster and more efficiently thus reducing the learning curve

	Recalling information quicker

	Eliminating stress and increasing confidence

	Studying techniques and eliminating anxiety in the classroom

When do you usually conduct your meetings?	Weekly Monthly Other

What day of the week?

What time are your meetings held?	AM PM

How many people will be attending?

What are their job functions?

Any additional information or questions that we should know?