2018 Greater Philadelphia Leadership Exchange Application
Thank you for your interest in GPLEX. This year's Exchange will take place September 30 - October 3 in Seattle! Participants are selected through a competitive process with a goal of representing the geographic, demographic, sector, and industry diversity of the region. To be eligible, applicants must live or work in the Greater Philadelphia region and serve in a leadership role in a business, nonprofit, or government organization. Completing the application will take around 15 minutes.

2018 registration fees:
- $2,000 for organizations with annual revenues under $10 million and all government agencies
- $3,000 for organizations with annual revenues over $10 million

Please note that registration fees do not include travel or hotel expenses. We have secured a room rate of $279 per night at The Westin Seattle, our host hotel.

Email address *
First name: *
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Last name: *
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Full name for print materials: *
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Organization name: *
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Job title: *
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Mailing address 1: *
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Mailing address 2:
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Mailing address city: *
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Mailing address state: *
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Mailing address zip code: *
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Business phone number: *
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Mobile phone number: *
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Twitter handle:
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Assistant name:
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Assistant phone number:
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Assistant email address:
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Organization website: *
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Organization's total annual revenues: *
Type of Organization *
Organization Sector (select all that apply): *
Required
Have you previously participated in the Leadership Exchange? *
Age: *
We ask only to help us achieve a diverse cohort of emerging and established leaders.
Gender: *
We ask only to help us achieve a diverse cohort.
Ethnicity/Race: *
We ask only to help us achieve a diverse cohort. You may check as many boxes as apply to you.
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If you were referred by a friend or colleague, please specify who made the referral:
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Where do you work (county)? *
Where do you live (county)? *
Briefly describe why you would like to participate in the 2018 Leadership Exchange. *
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Please list up to three (3) affiliations you have with other organizations and describe your role. Affiliations include board service and significant volunteer commitments. If you are selected to participate, this information will be included in print materials. *
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Is there anything else that should be considered in weighing your application?
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