Title

First Name *

Last Name *

Address Line 1 *

City *

State *

Enter required value

Postal Code *

Organization *

Job Title *

Email *

Cell Phone *

Polo shirt size (women's are women's cut) *

Enter required value Small Medium Large Extra Large 2XL 3XL 4XL

Do you have any dietary restrictions?

Emergency Contact Name

Emergency Phone

Why are you applying for LEADing Chester County and what do you hope to gain from the experience? *

Statement of Committment *

By submitting this application, I have read the Frequently Asked Questions document that includes pricing, payment and attendance requirements, and I commit to attend the August 29th kickoff and all seven classes in order to be considered an official/recognized completer of the program. I understand that these classes are offered in-person, and will remain in-person, unless CDC Covid recommendations change. My supervisor is aware and approves of my participation in LEADing Chester County. I also acknowledge my company will not be reimbursed if I drop out of the program once it begins. 

Enter required value Yes, I understand the program and submit my application.