Seminar Kit Order Form

Everything needed to publicize and host Take Your Best Shot is conveniently packaged in one box and will be shipped directly to you at no charge. The kit will contain enough materials for 50 participants. Millennium will only use the information you provide to send you the kit requested.

* Required Field

Title
First Name *
Last Name *
Email Address *
Phone Number *
Support Group Name *
Website
Please Indicate Setting for TYBS Seminar *
Support Group
Senior Center
VA Hospital
Support Group Name, Senior Center Name or VA Hospital Name *
Address *

Street Address
The Take Your Best Shot kit is only available in the United States.

Address Line 2

City

State / Province / Region

Postal / Zip Code



Estimated Number of Attendees *
When do you plan on holding your seminar? *
Best days of week/times of day to contact seminar host *

 

 

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