P.O. Box 1454  |  63 Puddle Lane-Strawbery Banke Museum  |  Portsmouth, NH 03802  |  Tel: 603.772.4488


Registration for Leadership By Designsm and Leadership in the Middlesm

We will use the information on this form as a reference throughout the process, so please take the time to fill in all of the information below.

Which course are you registering for?

Leadership By Design®
Leadership In The Middlesm

I. Personal and Professional Information
Business phone:
Emergency phone:
Years in a management role:
Years in current position:
No. of people you supervise:
Immediate manager's name:
Manager's title:
Manager's telephone:
Manager's email:
II. Your Views on Leadership

As a leader, what are three key areas or frustrations on which you want to focus your learning?

Have you participated in other formal leadership development programs? If so, please describe.

Why are you taking Leadership By Design?

What are your expectations of this leadership development process? What do you hope to learn?

Please describe the essential work of your group.
Register Now