2018-2019 Cohort Registration

To register for participation in the 2018-2019 Leadership for Life cohort, please provide the following information:

Contact Information
* denotes a required field
Name *
Name
Phone *
Phone
Home Address
Home Address
Do you require any special accommodations?
(Linguistic, dietary, physical, religious)
Emergency Contact
Leadership Role
Organization's Address:
Organization's Address:
Do you consider yourself:
(choose one)
Is your employer aware and supportive of the time and monetary resources required to participate in Leadership for Life?
Faith/Values Commitment
Experiential Background
Program Fees
Program fee: $3000 per person (Includes all costs for opening retreat, 8 monthly sessions, and all materials) The discounted price for non-profit organizations is $2200.
Check one: *
$
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.