Leadership Butts County 2019-2020
Registration Application
Note: This class is limited to 25 participants
Email address *
Name *
Age *
Gender *
Mailing Address *
Phone *
Email *
Employer/Organization *
Present Title *
Responsibilities *
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.). *
In your opinion, what are the three most pressing issues facing this community today? *
In your own words, define leadership. *
What do you hope to gain from the Leadership Butts County experience? *
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? *
I understand that I will have to pay tuition of $250 upon arrival if funds are not collected prior to the first meeting. *
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