women in leadership

Participant Agreement

"*" indicates required fields

Name*

First Last

Preferred Mailing Address*

Home

Work

Address*

Street Address Address Line 2 City State ZIP Code

Preferred e-mail address*

Enter Email Confirm Email

Preferred Phone Number*

Name as you would like it to appear on your official name badge:*

First Last

Please enter the information below as you would like it to appear on the press release

Name*

First Last

Job Title*

Organization*

Program Information

Do you have any dietary restrictions? If so, please indicate:

Do you have any dietary preferences? If so, please indicate:

i.e. coffee vs. tea

Do you require any special accommodations? If so, please describe your needs:

Emergency Contact

Name

First Last

Phone

Relationship To You

Schedule

Spring 2025 Women In Leadership Calendar

Participation in the program requires a commitment to be present at all seminars. By completing and submitting this agreement, you are making that commitment.

Financial Obligation

Tuition / Scholarship*

The investment/tuition in your growth and development in WIL is $2,500. Please indicate who the responsible party will be for your tuition below.

Applicant/Self

Employer

Other

There is limited financial assistance for WIL. To be considered for a scholarship, please complete form by January 22, 2025: Scholarship Application

All program fees are non-refundable. Tuition payment is due no later than March 8, 2025 and may be paid via credit card here.

Please check the box below to indicate your participation*

I will participate in the Women In Leadership program.

I will NOT participate in the Women In Leadership program.

Name*
First Last