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

Registration

Registration for Leadership On The Line® and Stepping Up to Leadershipsm

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 On The Line®
Stepping Up To Leadershipsm


I. Personal and Professional Information
Your Name:
Title:
Organization:
Email:
Business phone:
Emergency phone:
Years in a management role:
Years in current position
No. of people you supervise:
Immediate manager's name:
Title:
Telephone:
Email:
  
II. Your Views on Leadership

As a leader, what are 3 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 this leadership course?

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

Please describe the essential work of your group.
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