Leadership Butts County 2019-2020
Registration Application
Note: This class is limited to 25 participants
Email address *
Name *
Your answer
Age *
Your answer
Gender *
Mailing Address *
Your answer
Phone *
Your answer
Email *
Your answer
Employer/Organization *
Your answer
Present Title *
Your answer
Responsibilities *
Your answer
How much time each month do you commit to community, civic, professional & other organizations & activities? *
Please List all involvement in the Butts County community (civic, non-profit, business, religious, etc.). *
Your answer
In your opinion, what are the three most pressing issues facing this community today? *
Your answer
In your own words, define leadership. *
Your answer
What do you hope to gain from the Leadership Butts County experience? *
Your answer
Dietary restrictions *
The Leadership Butts County Program requires a commitment to attend meetings during normal business hours. Do you have the full support of your employer and are you prepared to commit yourself for the time required to participate effectively in the Leadership Butts County program? *
Required
I understand that I will have to pay tuition of $250 upon arrival if funds are not collected prior to the first meeting. *
Required
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