Leadership Pleasanton Application 2020-21 - Pleasanton Chamber of Commerce, CA

Leadership Pleasanton Application 2020-21
Name Block - Simple

First Name *

Last Name *

Present Employer *
If no employer, type N/A

Job Title *

Employer Address

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Home Address

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Work Phone Number *

Cell Phone Number *

Email *

Years living or working in the Pleasanton area *

What is your main motivation for wanting to participate in the Leadership Pleasanton program? *

What are your expectations for the program? *

Please list community, civic, professional, business, religious, social, athletic, and other organizations of which you have been a member. Please describe the nature of your participation, responsibilities and accomplishments you achieved.

The contribution (tuition) for each participant accepted into the program is $950. A limited number of partial scholarships of $475 are available. Will you find it necessary to seek such assistance? If yes, please give a reason. *

A continental breakfast and full lunch are provided at each session. Do you have any dietary needs, restrictions, strong dislikes? If yes, please explain. *
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