Leadership Registration Form


Leadership Registration Form

Personal Details

First
Last
Be as detailed as you can.

Business Details:

Family Details:

Who shared the Course with you? (Sponsor)

Repeating Students Only:

Emergency Contacts

Tuition

All prices listed in USD.

Payment Information

I acknowledge that I have read, understand and agree to all of the above terms and conditions, as well as the Refund Policy.

Medical and Psychological Information

Due to the participatory nature of the course, the following information is required to attend. This is done in order to provide the best learning environment possible for you and the other participants. Please answer the following questions by checking the appropriate response. Your answers are kept confidential except for possible disclosure to your physician, psychiatrist, psychologist or therapist, if applicable. If you have any questions or concerns regarding the following, please contact the Pathways office.
The Leadership Course is based on an educational model, not a medical model. None of the Pathways staff are licensed psychiatrists or psychologists.