2026-27 LeaderUP Training Application
Emerging Leader Registration Form
Name
*
First Name
Last Name
Employer or Sponsoring Organization
Job Title or Responsibility
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
E-mail
*
example@example.com
Company/Sponsor Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company/Sponsor Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Company/Sponsor Email
example@example.com
Applicant Date of Birth
-
Month
-
Day
Year
Date
Do you reside or work in Douglas County
Yes
No
List any food allergies or dietary restrictions
Tell us briefly why you desire to participate in the LeaderUp Douglas training Program.
Please upload a copy of your resume
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Please tell us of your participation in community organizations, employment and education that are not included on your resume (if any).
What's something about yourself that others would be surprised to learn?
Signature
*
Course Fee Payment Option
Invoice- Course fee $1,395 if paid by check, we will invoice company listed above and must receive payment prior to course beginning
Pay now with Credit Card (Course fee $1,435 if paid with card)
Leadership Training Fee- Pay now with Credit Card
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Leadership Training Fee
Fee per student (Includes $40 Square transaction fee)
$1,435.00
$
1,435.00
Credit Card
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