Intentional Leadership: Leading With A Purpose Class C.C. Form

Select Class Location *

Please print the pdf copy of the registration form and complete with all registrants attending. Upload or email to kcorvin@lhln.org.

Your Organization

Name *

First

Last

Rank or Position

Email *

State/Province *

Textable 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 Information

Billing Contact *

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Last

Billing Contact Phone *

Billing contact email *

Select Number of Registrations Purchased *

Registration 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

$ 0.00

Credit Card *

Card Number

Security Code

Name on Card

Expiration/

Email to send receipt of payment *

Phone of Cardholder *

Billing Zipcode for Card *

Special Instructions

This 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..