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The Change Course Registration

Register for The Change Course!

The Change Course Registration

Basic Information
Name*
First Last
Email*
Enter Email Confirm Email
I am registering (choose one):*
- As an individual learner. I am paying my own invoice.
- As a member of a team. I am paying my own invoice.
- My team. I will enter team info below and will pay for all registrations on one invoice.
What is your profession?*
Where do you work?
Where do you work?*
Please give a brief description of your organization.
Please give a brief description of your organization.*
Registration
Team Name*
Please coordinate with the other members of your team to select a shared name so we can group you together when the course launches (you are welcome to be creative!). Alternatively, list the names of all the members of your team here.
Select your team's start date.*
There are no options available for this field.
Note, the course is 7 weeks long.
Select your start date.*
There are no options available for this field.
Note, the course is 7 weeks long.
How many team members are you registering?*
For this pilot of The Change Course, we are capping teams at eight members. If you would like to register more than eight participants, please contact us at online@mindsatwork.com and we will help you create two (or more!) sub-groups.
Team Member 1: Name*
First Last
Team Member 1: Email*

Please make sure you type the correct email address as this is what we will use to sign your team member up on our Online Learning Portal.
Team Member 2: Name*
First Last
Team Member 2: Email*

Please make sure you type the correct email address as this is what we will use to sign your team member up on our Online Learning Portal.
Team Member 3: Name*
First Last
Team Member 3: Email*

Please make sure you type the correct email address as this is what we will use to sign your team member up on our Online Learning Portal.
Team Member 4: Name*
First Last
Team Member 4: Email*

Please make sure you type the correct email address as this is what we will use to sign your team member up on our Online Learning Portal.
Team Member 5: Name*
First Last
Team Member 5: Email*

Please make sure you type the correct email address as this is what we will use to sign your team member up on our Online Learning Portal.
Team Member 6: Name*
First Last
Team Member 6: Email*

Please make sure you type the correct email address as this is what we will use to sign your team member up on our Online Learning Portal.
Team Member 7: Name*
First Last
Team Member 7: Email*

Please make sure you type the correct email address as this is what we will use to sign your team member up on our Online Learning Portal.
Team Member 8: Name*
First Last
Team Member 8: Email*

Please make sure you type the correct email address as this is what we will use to sign your team member up on our Online Learning Portal.
I agree to abide by the Minds at Work cancellation policy.*
- By checking this box, I confirm that I have read and understand the cancellation policy.
Background Information
Name*
First Last
Email*
Enter Email Confirm Email
Have you attended a Minds at Work workshop before? (select all that apply)*
- Facilitator's Workshop
- Online Coach Development program
- The Coach Certification Program
- The Adult Development Assessment: The SOI
- Other
- I have not attended a workshop.
Have members of your team attended a Minds at Work workshop before?*
- Yes
- No
- I do not know
Which member(s) of your team attended a Minds at Work workshop?*
How much exposure does your team have to Immunity to Change™?*
- Some members of the team have read the book or heard about the process.
- Some members of the team have used or experienced the process, as individuals (but not as a team).
- Some members of the team have experienced the process together as a team.
- All members of the team have experienced the process together as a team.
- None.
- I do not know.
How much exposure do you have to Immunity to Change™?*
- I have read the book or heard about the process.
- I have used or experienced the process.
- None.
Is there anything else we should know about your team and/or its level of familiarity/exposure to the Immunity to Change™ approach?
Is there anything else we should know about you and/or your level of familiarity/exposure to the Immunity to Change approach?
How did your team learn about Immunity to Change™ Online?*
- Minds at Work newsletter
- Minds at Work website (mindsatwork.com)
- Way to Grow (waytogrowinc.com or Way to Grow Inc newsletter or social media)
- Personal outreach from Minds at Work affiliate
How did you learn about Immunity to Change™ Online?*
- Minds at Work newsletter
- Minds at Work website (mindsatwork.com)
- Way to Grow (waytogrowinc.com or Way to Grow Inc newsletter or social media)
- Personal outreach from Minds at Work affiliate
Billing Information
Payments are not processed through the Minds at Work website. After submitting this form, our finance team will supply an invoice with payment instructions.
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

office@mindsatwork.com
(617) 491-2656

PO Box 1386
Raymond, NH 03077

Overcome your IMMUNITY TO CHANGE^TM

Coaching for Individuals

Individual Coaching Arcs
The Change Course

Coach Development

Facilitator’s Workshop
- Qualified ITC Map Facilitator
Immunity to Change™ for 1:1 Coaching: Maps and Tests
Conducting the ITC Approach with Teams Online
Introduction to Robert Kegan’s Adult Development Theory
Adult Development Assessment: The SOI
Coach Certification Program

Newsletter Sign Up

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