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.

Program Schedule:
One session per month, September through April, 1 to 5 pm.
- September 17
- October 22
- November 19
- December 17
- January 21
- February 18
- March 25
- April 22
To ensure participants get the full value of the program, attendance is expected at all sessions, though one absence is permitted.
Basic Information
Name

First NameLast Name
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Birthday

MonthDayYear
Date
Do you have any food allergies? If so, please list.
What do you hope to take away from your time in Clive Emerging Leaders?
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.Format: (000) 000-0000.
Please upload a headshot or photo of yourself for our class roster.

Cancelof
Commitment from Employer and Participant
My employer and I understand the time requirement for this program means attending at least 7 of the 8 monthly sessions of Clive Emerging Leaders.

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 $395 is due by August 30, 2026. Once you submit this form, an invoice for the registration fee will be emailed to you.
Signature
Date

MonthDayYear
Date
Should be Empty: