Workshop Registration

Woohoo! You are attending a Heart Leadership Workshop soon, and we need some info from you in order for us to curate the best experience possible. Please complete the following form as soon as possible, and we look forward to seeing you at the workshop!

Attendee Name

First Name

Last Name

Company Name

Position/Title

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What is the biggest leadership challenge you are currently facing?

What is something you are hoping to take away from this workshop?

What is your favorite leadership quote?

Please provide the names and emails of two people you work closely with who are familiar with your leadership style:

Peer #1 Name

First Name

Last Name

Peer #1 Email

Peer #2 Name

First Name

Last Name

Peer #2 Email

Dietary Restrictions