AUTHENTIC LEADERSHIP REGISTRATION

We’re thrilled that you'll be joining us on our Authentic Leadership programme.

To ensure you get your desired results from the programme, we like to set you up for success from the start and also gather key information to help us, help you. We pride ourselves in tailoring our approach to ensure you get the most out of the programme. Everything below will help us achieve that.

This registration process will take approx. 5 minutes.

If you have any questions at any stage please don’t hesitate to let me know. We are totally committed to helping you achieve your programme goals.

CONTACT DETAILS

First Name

Last Name

Company

Title

Mobile Phone

Business Phone

DELIVERY ADDRESSES

Through the programme we will courier and post you items. Please let us know the best addresses below:

POSTAL ADDRESS

Postal Address

Postal Town/Region

City

Postal Post Code

BEST COURIER ADDRESS

Address

Town/Region

City

Post Code

Any special delivery instructions

RETREAT SPECIFIC INFORMATION

It’s important that we meet your specific requirements, please let us know if you have any.

Any Food Allergies

Food Preferences

Any medical conditions we need to be aware of

IN CASE OF EMERGENCY:

Emergency Contact Name

Emergency Contact Number

INFORMATION TO GET TO KNOW YOU

What attracted you to the Authentic Leadership programme?

What would you like to get out of the programme?

Any comments

PAYMENT DETAILS - if required

If we haven't already received this information, please let us know your preferred payment method and process.

Payment Preference

Invoice Direct Debit - 7 day payment Invoice Credit Card

Company Name - Invoice

Contact Person Name - Invoice

Contact Phone Number - Invoice

Email Address - Invoice

Order Number (if required)

Business Unit (if required)

Invoice Address

Acceptance

I have read, understood and accept Terms and Conditions. .
I authorise, the use of any photos or videos taken throughout the program, that include my image, to be published and utilised on the Leadership Collective website and in social posts, marketing and promotional activities.

Email Approval

I give approval to receive emails from Kirsten Leng and Leadership Collective

Your Registration form will submit following 'clicking' the TWO acceptance boxes above and hitting 'Send' below.

I really look forward to working with you.

Any questions, just let me know. I’m totally here to help you.

Cheers Kirsten
021-816304

[email protected]