2023 LEAP Connect: Wellness and Leadership Retreat

2023 LEAP Connect: Wellness and Leadership Retreat
To register for this program: Complete this registration form and submit your payment via the payment section below.

If you have any program questions, please contact:

Shahana Shah, Director of Development

sshah@leap.org

If you have any billing questions, please contact:

Grace Toy, Sr. VP of Administration and CFO

gtoy@leap.org
Getting to Know You:
Name*

First NameLast Name
Pronouns*
Job Title and Company
Email*
Mobile Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender*
For demographics only
Ethnicity*
For demographics only
Generation*
For demographics only
Your Stay at The Royal Hawaiian Resort Waikiki: Wellness and Leadership Retreat (September 17th - September 20th, 2023)

$2495 - Accommodations for 3 Nights
Dietary Restrictions/Related Allergies*
Are there any activities that you are unable to attend?*

Welcome MixerBreakfast and Mental Health ConversationNone
Hotel Arrival Date*
You will be able to purchase a room block rate for three days before or after the retreat to extend your stay in Oahu. If you choose to extend your stay, please contact choang@leap.org after you complete this form to confirm details.
Hotel Departure Date*
You will be able to purchase a room block rate for three days before or after the retreat to extend your stay in Oahu. If you choose to extend your stay, please contact choang@leap.org after you complete this form to confirm details.
As an API, have you experienced racial trauma as a result of the pandemic and rise in anti-Asian hate? *
Have you identified meaningful exercises that have helped you navigate through your emotions? If so, please describe them. *
In which ways do you believe this retreat will be beneficial for you? *
EMERGENCY CONTACT
Emergency Contact Name*

First NameLast Name
Relationship to You*
Emergency Contact Phone Number*

Area CodePhone Number
PROGRAM ACCEPTANCE AND CANCELLATION POLICY
Cancellations & Refunds:
- Ticket purchases are nonrefundable. If you are unable to attend, transfer of tickets may be considered. Please reach out to Shahana Shah at sshah@leap.org with any questions.
PROGRAM FEE & PAYMENT

Submit your payment via the payment section below.
How will you pay*

Credit Card

My Products*

Wellness and Leadership Retreat Registration

$2,495.00

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Total

$0.00

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Additionally, by submitting my application, it is understood that any photos or videotapes of participants may be use in future marketing publications. I also confirm that the information that I am submitting is true and to the best of my knowledge.
By typing my full name in this box, I have read and agree to the Registration and Cancellation Policy stated above.*
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2023 LEAP Connect: Wellness and Leadership Retreat

Getting to Know You:

Your Stay at The Royal Hawaiian Resort Waikiki: Wellness and Leadership Retreat (September 17th - September 20th, 2023)

EMERGENCY CONTACT

PROGRAM ACCEPTANCE AND CANCELLATION POLICY

PROGRAM FEE & PAYMENT