Referral Form

Referral Form

For when you only have the bare minimum info for a potential event lead.
Facilitator Name*

First NameLast Name
Please choose one of the following referral types:
- Return: – Contact that has been to us who wants to return.
- Attendee: New contact that is an attendee at an event and wants to bring a different group.
- Referred Contact: New contact who is not present at a Group Dynamix event but was referred to us by an attendee.
- Personal Sales Commission: New contact not generated from a Group Dynamix event, but rather staff member's personal contacts.
Type of Referral*

ReturnAttendeeReferred ContactPersonal Sales Commission
Client Name*

First NameLast Name
Company/Organization Name*
Client Email*
example@example.com
Client Phone*

Area CodePhone Number
Type of Client

AdultStudent
Desired Date of Event

MonthDayYear
Date
Participant Number
Notes
Should be Empty: