Welcome to the work of Heather Steele, Legacy Training and Steele Communications, Inc. Congratulations on your commitment to your happiness and personal growth. Please fill out the required registration/release form needed for coaching, training, seminars, intensives and retreats. To reach Heather directly please email her at: heather@heathersteele.com or call her personal line at: 303-941-9693

Name (required)

Address

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone


CellHomeWork/Office

Email (required)

Birthday

How did you hear about us?

Please list any dietary restrictions

Emergency Contact Information:

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

CellHomeWork/Office

Please check which of the following apply to your registration:

CoachingIntensives (Individual, Couples)Legacy Coaching Certification: I, II, III, IV (Nederland, Cheyenne, Sedona)Just Us: Couples Weekend Retreat (overnight)UP (Unlimited Performance) Leadership Ropes Course & RetreatWindRiders Adventure Camp (Cheyenne)WindRiders UPRadiance for WomenAscension for WomenWIN Retreat: World Impact Now

If you are registering for coaching, please describe your top three priorities that you would like to work on.

Please list any recreational or prescription drugs you are taking including marijuana and alcohol. Please be specific about how much and how often.

Are you under the care of a psychiatrist? If "yes" please list who and a phone number.

By typing your name below (required) you understand this is a liability release form and you shall indemnify, save and hold harmless Steele Communications Inc., Legacy Training Institute, Heather Steele and/or any person affiliated in any manner. You acknowledge that you have read the services and rates page in full. You understand that coaching is not therapy and you are committed to and responsible for your growth and development. All tuition and payments are non-transferable / non-refundable.