Clive Emerging Leaders Registration Form

Clive Emerging Leaders Registration Form
This program fosters career growth for young professionals by promoting relationship building and facilitating professional development opportunities. Resulting in a confident, educated, and prepared workforce of emerging professional leaders. Ideal applicants are young professionals seeking to establish new connections and acquire essential skills and knowledge to become effective leaders.

Benefits of the program included:
- Networking Opportunities
- Professional Development Workshops
- Mentorship Program
- Access to Industry Insights
- Confidence Building
- Community Engagement
- Leadership Skills Development
- Personal Growth and Fulfillment
Basic Information
Name*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthday*

MonthDayYear
Date
Employment

Participants must be an employee of a Clive Chamber member in good standing.
Employer/Business Name*
Job Title*
Employer/Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Email*
example@example.com
Work Phone Number*
Please enter a valid phone number.
Commitment from Employer and Participant
My employer and I understand the time requirement for this program means attending all the monthly meetings of Clive Emerging Leaders. Program sessions will be in the afternoon (three or four hours) once a month.

My employer and I also understand that participation in Clive Emerging Leaders means the company/organization must be a member of the Clive Chamber of Commerce in good standing.

Registration fee of $295 is due by August 30, 2024. Once you submit this form, an invoice for the registration fee will be emailed to you.
Participant Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Clive Emerging Leaders Registration Form

Basic Information

Employment

Commitment from Employer and Participant