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Contact Name:
Title:
Organization:
Phone Number:
Email Address:
Date of Visit:
Arrival Time:
Departure Time:
Names/Titles of participants who will be visiting:
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What are the outcomes you are hoping to obtain from this visit?
Please indicate the level of commitment your organization has to implementing Lean Six Sigma:
Where is your organization currently in deploying Lean Six Sigma?
In what areas or departments of your organization do you feel Lean Six Sigma would be beneficial?
Please list questions below you would like addressed during your visit:
Are you willing to participate in a Lean Six Sigma user group?
The cost of the session is $50.00 per person and must be paid 5 business days before the session. An invoice will be mailed to the contact person listed above.
Lunch preference (indicate # of people for each selection):
Roast Beef
Turkey
Ham
Vegetarian
For additional questions or comments contact: Kate Love-Jacobson (260) 427-1185, Professional Development and Quality Enhancement Manager

High Performance Government Executive Overview
Registration / Pre-Visit Survey
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