Name*

Full Address*

Contact Phone/Cell*

Contact Email*

Web URL

Current Employer*

Current Role*

What are your goals for joining this leadership development series?*

Please review our eight (8) principles, which most resonates with you and why? (It could be as a potential growth area, or based on your comfort level)*

Commitment Statement

I understand that my success as part of the Emerging Leaders program depends on active participation and shared learning. I understand that this series consists of two monthly morning 90-minute sessions that build, and that my success hinges on my ability to attend all of the sessions.

I commit to be present, participate fully and prepare for each session as requested.

Selecting this will serve as your electronic signature

Date*

Program Pricing

The ATHENA Emerging Leaders program cost is $500.00 per participant. This includes program materials, all sessions of Master classes and any related networking/other event during the program cycle.

Company Sponsored?

Interested candidates are encouraged to work with their employers for possible reimbursement. See our document

Company Name

Company Contact

Interested in Scholarships

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