THE LEADERSHIP COURSE! 6 SESSIONS OF FUN!

Request edit access

LEARN SUCCESS! MEET POWERFUL CEOs. QUALIFY FOR INTERNSHIPS. EARN $250. RECEIVE A DIPLOMA UPON CONCLUSION. WE MEET at BJX 2915 Ave. K 6pm- 8pm. BEGINS WEDNESDAY (and every Wed thereafter)!

The ULTIMATE Leadership Course!

First name? *

Last name? *

Your email? *

We keep all info private

Who referred you? *

Please specify.

Whats your cell #? *

We may need to reach you. We promise that we won't share it:-)

What High School do you attend? *

Please specify. Tell us what year you're in.

Is your mother Jewish? *

We do not share any of your information.

Yes, she was born Jewish

She converted to Judaism

No, she is not Jewish

What are your hobbies? Did you receive any awards/scholarships? *

We do not share any of your information.

We require that you submit a recent photo of yourself. Please submit it now. *

Email photo to info@bjxcenter.com

I Just emailed my photo. Thanks!

I will email my photo within 24 hours. Thank you.

Please type your full address and your d/o/b *

All info is kept strictly confidential.

Please join our Whats App Group *

This is how we stay in touch. Text "Leadership Course & your name" to 718-809-4574 to join.

Just did! I want to know all about what's going on!

Required

Please provide Name and Cell phone of Emergency contact *

Mom

Dad

Name and Cell phone of Emergency contact *

By applying for the Leadership course I agree to come for 6 weeks & attend a local "spectacular" Weekend with the CEOs at the end of the program. *

It will take place in Midwood/hosted at BJX with full hospitality and lodging. Failure to attend will disqualify you from receiving your $250 stipend.

By checking this box I understand that to receive my stipend I must attend the 3 Gourmet Meals & Exclusive Weekend.

Required

Submit

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms