Name *

First Name

Last Name

Phone Number *

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Mailling Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Understanding of Commitment *

I understand that by making a commitment to the program, Leadership Grundy, I am committing one working day (8am to 5pm) per month from September through May (except December). I understand that an attendance policy will be applicable and that I will be asked to abide by it in order to remain in the program.

Understanding of Program Fees *

I am applying to Leadership Grundy and will remit the $50.00 application fee to the LG office within 2 business days. I understand that, if accepted, the remaining program fees associated with my participation in Leadership Grundy will be covered by the community and business sponsors that contribute to Leadership Grundy.

My organization would like to sponsor my participation in Leadership Grundy. I have discussed this with my sponsor and have their full backing and understanding of program expenses. If I am accepted to Leadership Grundy, my sponsor will contact the LG office within 5 business days of acceptance to discuss sponsorship.