Emerging Leaders Alliance


REGISTRATION FORM

 
     
     
The address I am providing is my:
     
 
 

Dietary Restrictions or Allergies

 
 
 

Special Aids

 
 
Release/Permission: ELA reserves the right to make video/audio recordings and to take still photography during this workshop.  My submission of this Registration form shall constitute my permission for ELA to use my voice, image, and likeness in any such photograph or video/audio recording, and to reproduce, distribute, display, sell, or otherwise use these photographs or recordings for any purpose, whether commercial or noncommercial in nature.
 
Please make payment below (US$1,500)

Payment Information

     
Pay by Check:
  (Check should be payable to AIST, in U.S. dollars and drawn from a U.S. bank) and mailed to:  Emerging Leaders Alliance, c/o AIST, 186 Thorn Hill Rd., Warrendale, PA 15086.
     
 
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