WILD Registration

Thank you for registering for WILD!

WILD Registration
Louisville - Dates to be Announced Soon

Submit this form to register for the WILD: Women Impacting Leadership Development Program in Louisville, Kentucky.

Registration into this event includes four 2-day sessions, five one-on-one coaching sessions outside of group settings, emotional intelligence assessment and all curriculum. Also included are meals and materials.

Registration

I am registering: *

For Myself For Someone in Our Company

* Indicates required field

Participant Name *

First

Last

Email Address: *

Confirm Email Address: *

Work Phone Number: *

Cell Phone Number: *

Administrative Assistant's Name (if applicable): *

First

Last

Administrative Assistant's Email (if applicable) *

Company Name: *

Participant's Title: *

Business Address *

Line 1

Line 2

City

State

Zip Code

Country

Supervisor's Name: *

Supervisor's Email Address: *

Supervisor's Phone Number: *

Background Information of Participant

How many people, if any, do you directly supervise? *

How long have you been in your current role? *

What is your educational background? *

What is your LinkedIn Profile URL? *

How many years have you been in a leadership role? *

GET WILD!

WHEN:
To be determined
Program days are 9am-4:00pm unless otherwise noted.

WHERE:
E.P. Tom Sawyer State Park
Sawyer Hayes Community Center
2201 Lakeland Road
Louisville, KY 40241

PAYMENT:

After your registration form is submitted, we will contact you for payment information.

PROCESS:
Once you are registered, you will be contacted for payment information. You will then be sent more program information and consent form.

CONTACT:
Belinda@BelindaGates.com
502-544-0950