I certify that all of the statements made in this application are true, complete, and correct to the best of my knowledge and are made in good faith. I know and understand that all items may be verified. As a part of my registration, I have company/organization support for my participation, where applicable.  I will remit to Leadership Women the non-refundable registration fee of $500 to secure my participation and understand that I will be responsible for the balance due by the deadline.

Submitting this form constitutes acceptance of the terms and conditions found in the registration above.