Registration Form

Program Registration Form
PERSONAL INFORMATION
First Name
Last Name
Job Title
Company Name
Direct Phone Number
Format: (000) 000-0000.
Cell Phone Number
Format: (000) 000-0000.
Email
Company Address

CityProvince / State

Postal / Zip CodeCountry
PROGRAM INFORMATION
Which program would you like to register for?
Greenbelt Program Location
Lean Agile Program Type
Whitebelt Program Location
Blackbelt Program Location
Executive Program Name
In-House Program Location
Program Season
How will you be paying?
What is your shirt size?
What is your jacket size?
Program Location
What name would you like to appear on your program certificate?
e.g. John Smith, John A. Smith, John Adam Smith, John A. Smith Jr etc.
Greenbelt Candidates Only - Have you completed the Myers-Briggs Type Indicator (R) (MBTI) personality inventory?
If yes, how long ago did you complete the assessment?
Are you a Lean Sensei Greenbelt or Blackbelt graduate?
SPONSOR'S DETAILS
Are you being sponsored to complete this program?
Sponsor's First Name
Sponsor's Last Name
Sponsor's Job Title
Sponsor's Phone Number
Format: (000) 000-0000.
Sponsor's Email
DIETARY RESTRICTIONS AND HEALTH CONDITIONS
All of our in-person workshops are catered. Do you have any food allergies or restrictions?
I am allergic to (check all that apply)

Other
Allergies
I am unable to eat (check all that apply)

Other
Restrictions
Do you have any notable health conditions that we should be aware of? (Optional)
Health Condition Details
PERSONAL EMERGENCY CONTACT DETAILS (Optional)
Personal Emergency Contact Name
Relationship to you
Phone Number
Format: (000) 000-0000.
Alternate Phone Number
Format: (000) 000-0000.
Email
WORK EMERGENCY CONTACT DETAILS (Optional)
Work Emergency Contact Name
Relationship to you
Phone Number
Format: (000) 000-0000.
Alternate Phone Number
Format: (000) 000-0000.
Email
TERMS AND CONDITIONS
Terms and Conditions
Video and Photo Waiver
Release of Contact Information
Should be Empty:

Program Registration Form

PERSONAL INFORMATION

PROGRAM INFORMATION

SPONSOR'S DETAILS

DIETARY RESTRICTIONS AND HEALTH CONDITIONS

PERSONAL EMERGENCY CONTACT DETAILS (Optional)

WORK EMERGENCY CONTACT DETAILS (Optional)

TERMS AND CONDITIONS