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Registration Opens May 2011

After you complete the form below you will be directed to a payment page where you choose which Module you are registering for.
  • Payment options include 'pay in full' or 'deposit' with monthly payment plan.
  • Module One ~ The Leaders Foundations $695 – Individual Cost includes: Orientation, Materials, Conference Calls and Group Coaching (Begins August 2011)
  • Module Two ~ Leadership Issues $495 ~ Individual cost included: Materials, Calls and Group Coaching
  • Module Three ~ Leading a Focused Life $695 - Individual cost includes: Retreat, Materials, Conference Calls and Group Coaching (Begins March 2012)
Air and ground transportation for the March Module, is not included in the registration costs. 

 
First Name: *
Last Name: *
Date of Birth: * Calendar
Gender: *
Home Address 1: *
Home Address 2:
City: *
State: *
Zip: *
Home Phone:
Cell Phone: *
Email Address: *
Website URL:
Marital Status: *
Spouses name if married:
Anniversary Date if married:
Childrens Name (and Ages):
CAREER/MINISTRY INFORMATION
Current Career/Position: *
Company/Organization:
Work Address 1:
Work Address 2:
Work City:
Work State:
Work Zip:
Work Country:
Work Phone:
Work Email:
SPIRITUAL INFORMATION
When and how did you become a Christian: *
What is your church heritage: *
What church you are currently attending: *
What are you Spiritual gifts/other abilities: *
What are you passionate about: *
Current serving role(s) at your church: *
The primary things I hope to get out this course: *
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