Road to Success Registration January 2023

Thank you for your interest in our January 2023 Road to Success Program, a series of 6 sessions for women, designed to help enhance your personal and professional development.

This is a 6-week commitment that will be held on Wednesdays either at Dress for Success Palm Beaches at 2459 S. Congress Ave, Suite 204, Palm Springs, FL 33406, or via Zoom. This is a hybrid class that will run from January 25, 2023 through March 1, 2023 from 9:30 am - 12:30 pm.

To register for the class, please complete the information below. If you have any questions, please call us at (561) 249-3898.

After you register, our program facilitator will contact you with additional details on the requirements of this class.

We are here to help you map your road to success, and we look forward to seeing you in class!

Dress for Success Palm Beaches

561-249-3898

Road to Success Registration Form

First Name *

Last Name *

Email *

Address Line 1 *

Address Line 2

Phone

City *

State *

Zip *

Cell Phone * The phone field Cell Phone is required.

Client Age * The numeric field Client Age is required.

Date of Birth * The date field Date of Birth is required.

Education * The field Education is required.

Is Client a Veteran? * The field Is Client a Veteran? is required.

Does Client Receive Public Assistance? * The field Does Client Receive Public Assistance? is required.

Marital Status * The field Marital Status is required.

Children? * The field Children? is required.

Number of Children * The numeric field Number of Children is required.

How many under 18 live with you? * The numeric field How many under 18 live with you? is required.

Race * The field Race is required.

Clothing Size * The field Clothing Size is required.

Shoe Size * The field Shoe Size is required.

Who referred you to this program? * The field Who referred you to this program? is required.

Will you be attending this series virtually or in person? * The field Will you be attending this series virtually or in person? is required.