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


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:
Business phone:
Emergency phone:
Years in a management role:
Years in current position
No. of people you supervise:
Immediate manager's name:
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.
Register Now