2017-2018 Application

To register for participation in the 2017-2018 Leadership for Life cohort, please provide the following information:

(You may also download the PDF registration form and email it to info@lflomaha.org. LFL Registration 2017-18

(* notes a required field)

Contact Information

Phone Numbers
(leave blank if you prefer not to be contacted at this number)

Emergency Contact

Do you require any special accommodations? (Linguistic, dietary, physical, religious)  Yes No

Leadership Role

Type of Work or Industry:

Name of Business or Organization:

Do you consider yourself: (choose one)
 Young Professional Mid-career Senior Executive

Is your employer aware and supportive of the time and monetary resources required to participate in Leadership for Life?
 Yes No

List three other leadership roles you have held that reflect your leadership capacity:


Faith/Values Commitment

Declared Faith Tradition/Denomination:

Identify an aspect of your life that best demonstrates your faith or values commitment:

Experiential Background

List your top three challenges as a leader which you hope to address through LFL:


Program Fees

Program fee: $2750 per person (Includes all costs for opening retreat, 8 monthly sessions, and all materials)

Check one:*
 I will be personally responsible for ensuring all program fees are covered. My employer or the person listed below will ensure all program fees for my participation are covered.

Name and title of sponsoring party:

I would like to apply for partial program fee support in the amount of:
$

By submission of this application, I accept the terms of Leadership for Life including attendance, funding, and participation.

The course deposit, due upon registration, is $850.