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

        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______________________________________________________________

          ______________________________________________________________________________

          ______________________________________________________________________________

           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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