Length of Program
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
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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_____________
| Co-Sponsor(s), if any with contact person and E-mail |
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| Please list other Questions you may have |
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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.
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Gloria "Jo" Floyd, NCEHS, 14439 N.W. Military highway, #108, PMB 615 San
Antonio, TX 78231 [O] 210-698-8700, [F]
210-698-8701,
email: info@ncehs.com;
www.ncehs.com; or
www.DrGloriaJoFloyd.com
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