Leadership Development Series Registration – Insert Launch date

 

Location: Insert name and address of host location

Time: The first workshop is 4-1/2 hours in length: 8:00 a.m. – 12:30 p.m. Remaining workshops are 4 hours: 8:00 a.m. – 12:00 p.m.

Cost: The Series will consist of 12 workshops and 12 one-on-one coaching sessions, to be held once each month for 12 consecutive months. Workbooks and other support materials will be provided for each participant. The Series cost includes a one-time fee of $650 USD for the Series materials and $475 USD per month for 12 months for the workshops.

 

Company *

 

Participant Information

 

First Name *

 

Preferred First Name (i.e. Joe vs. Joseph) *

 

Last Name *

 

Title *

 

Company’s Physical Street Address *

 

City *

 

State: *   (pull down)

 

 

Zip Code *

 

Email Address *

 

Confirm Email *

Office Phone *

 

Cell Phone (for short notice class cancellations, i.e. inclement weather) *

 

 

Manager’s Information

 

Manager’s Name *

 

Manager’s Title *

 

Manager’s Phone *

 

Manager’s Email *

 

Manager’s Email Confirmation *

 

 

Billing Information

 

Billing Attention *

 

Billing Address *

 

Billing City *

 

State: * (pull down)

 

 

Billing Zip *

 

Additional Billing Information (PO#, separate invoice, etc.)

 

 

 

Invoice Preference *

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Confirm Email

 

 

A/P Information

 

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Accts Payable Phone *

 

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Preferred Payment Terms *   (pull down – Monthly, Quarterly, One Invoice Payment in Full)

 

 

 

Who Referred You? *

 

Please click SUBMIT one time and wait until the order is processed. You will receive a confirmation on-line and via email. Duplicate registrations may occur if you click SUBMIT more than once. Thank you!

 

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