Workshop Information Sheet
Complete the workshop information below. All fields with an asterisk (*) are required. If you cannot view the entire form, please reduce your font size and/or font type by adjusting your browser settings.
For any questions, contact PCA Partner Administrator at pca_administration@positivecoach.org or call 866-725-0024.

Organization Name: Clark Recreation

Workshop*: Double-Goal Coach: Coaching the Mental Game
Start Date*:    Start Time*:    End Time*:
PCA requests at least 14 days advance notice to schedule and conduct workshops.

Number of Workbooks:
Indicate the TOTAL number of books needed for this workshop. If you have previously submitted a book order and you are now submitting a change in the order, enter the TOTAL number of books needed. Please disregard the default number (1).
Books
All books are shipped from PCA's National office in California, allow 10-15 days shipping to avoid expedited shipping fees. Please order carefully-PCA has a NO RETURN Policy on workbooks.

On Site Contact:
First Name*:
Last Name*:
Mobile*:
On Site Contact:
Email Address*:
Alternate On Site Contact:
First Name:
Last Name:
Mobile:

Workshop Location
Loc. Name & Room Name/Number:
Address 1:
Address 2:
City*:
State*:
Zip*:

Material Shipping Address (No P.O. Box numbers)
First Name*:
Last Name*:
Address 1*:
Address 2:
City*:
State*:
Zip*:

Trainer Travel Information (only Partners outside of a PCA region). A rental car will be reserved for the trainer. If you have alternate transportation arrangements for the trainer, please identify in field below. Identify the closest airport and any recommended hotels.

Other events scheduled for the same date/time as the PCA workshop or any other concerns:

PCA asks you to provide the following at the Workshop Site:
  • Seating (non-hierarchical, conducive to audience participation and discussion)
  • LCD Projector
  • Microphone (If 75 or more attendees)
  • Name Tags (Recommended/Optional)
  • Pens/Pencils
  • Screen or Blank Wall Space

Equipment Information - Identify equipment that you CANNOT provide:
Redefine "Winner"
Honor the Game!
Fill Emotional Tanks