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Full Name
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Preferred Email
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What is your mailing address?
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Company/Organization
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How many years have you been in a leadership role(s)?
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What is your current role at work?
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Please list any organizations that you are closely tied to, either as a board member, dedicated volunteer, or by your family members.
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Have you ever taken the Insights® Discovery evaluator?
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Why does the Leadership Circle interest you?
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What would you like to get out of the program?
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