LAAL Workshop Enrollment - Convergency Systems

Living As A Leader Leadership Series

Location and Date (select one)*
Options #1 & #2 are a year-long commitment Option #3 is a six month commitment
Company*
Participant Information:
Name*
First Last
Preferred First Name (i.e. Joe vs. Joseph)
Title*
Company's Physical Street Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Office Phone*
Cell Phone (for short notice class cancellations, i.e. inclement weather)*
(required for short notice class cancellations, i.e. inclement weather)
Email*
Enter Email Confirm Email
Manager's Information:
Name*
First Last
Title*
Office Phone*
Email*
Enter Email Confirm Email
Billing Information:
PAYMENT OPTIONS*
First Payment Due at Registration - $925 books/App/Technology plus $695 first workshop and coaching session payment*
Price:
The monthly payment option includes books/mobile app/eLearning technology plus the first workshop. You will be charged $695 monthly for the remaining workshops and coaching sessions.
First Payment Due at Registration - $925 books/materials plus $2,085 first quarterly workshops and coaching sessions payment*
Price:
Quarterly payments include a one-time charge for books/mobile app/technology tools and three workshops and coaching sessions.
Pay in Full at Registration - $925 books/mobile app/technology plus $8,340 for 12 workshops and coaching sessions payment*
Price:
Paid in Full includes one-time payment for all books, mobile app, and eLearning tools plus 12 workshops and coaching sessions.
Company's Billing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Additional Billing Information (PO#, separate invoice, etc.)
Invoice Preference (required):*
- Email
- U.S. Mail
If Email, please provide Email Address*
Enter Email Confirm Email
A/P Information:
A/P Contact Name
A/P Contact Phone
A/P Contact Email
Enter Email Confirm Email
Please click REGISTER NOW button one time. If you are paying by credit card online, you will be directed to PayPal for secure payment processing. You will receive a confirmation on-line and via email. Thank you!
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.

Living As A Leader Leadership Series

Participant Information:

Manager's Information:

Billing Information:

A/P Information:

Creating Transformational Leaders