I am registering for the:

June 2008 Community Leadership Class - $1,595 (includes $50 annual Sustaining Membership)
October 2008 Community Leadership Class - $1,595 (includes $50 annual Sustaining Membership)
January 2009 Community Leadership Class - $1,595 (includes $50 annual Sustaining Membership)

Name:
Address:
City:   State: Zip:
Phone: Email:

Subsequent mail from Leadership Evansville should be sent to:
Business Address      Home Address

Employer:
Job/Title:
Employer Address:
City: State: Zip:
Business Phone:   Cell Phone:
Work Email:

Organizations/Activities: Please list three organizations/activities for which you are/have been a volunteer and/or community activities in which you have participated:

Please read and affirm the following statements:
1. I affirm that attendance is vital to successful completion of this program and to fulfilling my obligations to fellow participants /team members.  Initial:
2. I have reviewed the class schedule, and I have made appropriate arrangements to ensure my participation barring emergencies.  Initial:
3. I affirm that full tuition is payable upon registration (unless other arrangements have been approved by the Leadership Evansville Staff).  See payment options below.  Initial:

Payment Options:
Class Tuition:  $1,595.00
OPTION 1: Full payment will be mailed to the LE office immediately.
    Please make check payable to: Leadership Evansville, Inc.
    1007 Parrett Street, Evansville, IN 47713
OPTION 2: I will pay by credit card (MasterCard or Visa ONLY).
   Please call the LE office at 812/425-3828 to provide information.
    DO NOT e-mail or otherwise electronically submit credit card information to LE.
OPTION 3: Please send invoice to my employer addressed to:
    Name:
OPTION 4: I am in need of financial assistance.
    An LE representative will contact you to discuss financial assistance.