Center for Women - Smart Leadership Registration Form

Organization/Company Contact Information

Company/Organization Name
Country
State / Province*
Address
City
Email*
Confirm Email*
Phone*

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please indicate who and where you would like the invoice to be sent below.

 

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Invoice contact information

Participant #1 Information

Please tell us more about the participant(s) from your organization. Note: you must have at least one participant.

Name*
Title*
Email address*
To whom does this person report to (title)?*
How many direct reports does this person manage?*
How many year has this person worked with this company/organization?*
Does this person have a role in diversity/inclusion/change? (If so, what role?)*

Participant #2 Information

Name
Title
Email address
To whom does this person report to (title)?
How many direct reports does this person manage?
How many years has this person worked with this company/organization?
Does this person have a role in diversity/inclusion/change? (If so, what role?)

Participant #3 Information

Name
Title
Email address
To whom does this person report (title)?
How many direct reports does this person manage?
How many year has this person worked at this company/organization?
Does this person have a role in diversity/inclusion/change? (If so, what role?)

Participant #4 Information

Name
Title
Email Address
To whom does this person report (title)?
How many direct reports does this person manage?
How many years has this person worked at this company/organization?
Does this person have a role in diversity/inclusion/change? (If so, what role?)
Additional Comments

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