Intentional Leadership: Leading With A Purpose Class C.C. Form Please enable JavaScript in your browser to complete this form.Select Class Location *Palm Springs, CA (Mar 8-10, 2021)Portland, ME (April 13-15, 2020)Boulder, CO (April 20-22, 2021)Hampton, NH (May 4-6, 2021)Biloxi, MS (June 14-17. 2021)Wells, ME (Oct 5-7, 2021)Please print the pdf copy of the registration form and complete with all registrants attending. Upload or email to kcorvin@lhln.org. Your OrganizationName *FirstLastRank or Position Email *State/Province *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonTextable Phone *Please upload list of registrant(s) Click or drag a file to this area to upload. You may send either a word file or use our pdf file under "check request form" To secure each spot, each registration requires a name, rank/position, testable phone and email address.Payment InformationBilling Contact *FirstLastBilling Contact Phone *Billing contact email *Select Number of Registrations Purchased *1 registration - $ 495.002 registrations - $ 990.003 registrations - $ 1,495.004 registrations - $ 1,990.00Registration is $495/registrant. We understand that schedules change and you may not be able to attend. If this happens, we will work with you to find another class location that suits your schedule. In the event that a refund is issued, a $100.00 fee will be withheld. Need to register 5 or more? Please email Kelle Corvin about volume discounts at kcorvin@lhln.org.Total$ 0.00Credit Card *Card NumberSecurity CodeName on CardExpirationMM123456789101112/YY2122232425262728293031Email to send receipt of payment *Phone of Cardholder *Billing Zipcode for Card *Special InstructionsThis field is provided so to let the host agency and CCG know if a student attending will need any special assistance, such as "on crutches" or "needs wheelchair access" or need a seat close to the front for hearing/seeing issues or other related issues..WebsiteSubmit