Registration Request

* indicates required fields

• First Name: *
• Last Name: *
• Employee ID: *
• Title: *
• Department: *
• Telephone: *
• Western Email Address: *
• Campus Address: *
• Department Speedcode & Account (e.g. AB99 631800): *

• 
  (Used only if a Withdrawl Fee is charged)

• Number of people you directly supervise: *
• Number of years in a Leadership/Supervisory role: *

Please select the program you wish to attend based on the 2011-12 Schedule: *

• Group FL43 -FULL-
  PART 1: Understanding Leadership on Feb 1, 8 & 14, 2013 8:30am - 4:30pm
  PART 2: Leadership Effectiveness Training (L.E.T.) on Mar 28, Apr 3 & 4 2013 8:30am - 4:30pm
  PART 3: 1/2 Day Refresher on June 27, 2013 8:30am - 12:00pm
  PART 4: 1 Year Follow-up on Feb, 2013 (TBD) 9:00am - 4:00pm

Sessions are restricted to the first 18 participants who register.

You will be notified by email as to the status of your registration request.