Class Registration

Thank you for your interest in the Community Leadership Program. Please use the following form to register for an upcoming class. Be sure to fill in all fields that apply.

Our February 2012 class is full at this time. There are still opportunities for enrollment in the June 2012 and October 2012 classes. If you would like to be put on a waiting list please call the LE office at (812) 425-3828 for details.

* Required

Select a Community Leadership Class Date *
06/05/2012 - 06/07/2012
10/23/2012 - 10/25/2012

Title

First Name *

Last Name *

Email Address *

Home Address *

City *

State *

Zipcode/Postcode *

Country *

Home Phone Number *

Cell Phone Number

Organizations/Activities: *

Subsequent mail from Leadership Evansville should be sent to *
Business Address
Home Address

Company *

Job/Title *

Work Address *

City *

State *

Zipcode/Postcode *

Country *

Work Phone Number *

Send invoice to this person:

Payment *
Mail full payment to LE office
Credit Card (MasterCard or Visa only)
Invoice employer
Request financial assistance

1. I affirm that attendance is vital to successful completion of this program and to fulfilling my obligations to fellow participants/team members. Initial: *

2. I have reviewed the class schedule and I have made appropriate arrangements to ensure my participation barring emergencies. Initial: *

3. I affirm that full tuition is payable upon registration unless other arrangements have been approved by the Leadership Evansville staff. Initial: *

Enter Word Verification in box below *