Women in Health Leadership 2024

Women in Health Leadership 2024

First Name*

Last Name*

What would you like us to call you? (For example Liz vs Elizabeth; Bob vs Robert)

Preferred Pronouns*

Business Email

Personal Email*

What is your preferred email address?*

Business Phone Number

Personal Phone Number*

What is your preferred phone number?*

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Title/Position*

Present Employer*

Credentials (if none, N/A)*

Business Mailing Address

Business Street Address*

Business Address Line 2

Business City*

Business State*

Business Zip Code*

Home Mailing Address

Home Street Address*

Home Street Address Line 2

Home City*

Home State*

Home Zip Code*

Are you a graduate student or resident?*

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How did you hear about our Women's Seminar Series?*

Enrollment Fee and Tuition

Enrollment Fee: $25

Tuition: $900

Invoicing schedule:

Step 1: In the coming weeks after your enrollment, you will receive an invoice for a non-refundable enrollment fee of $25.00.

Step 2: At least 30 days prior to the start of the seminar series, you will receive an invoice for the full tuition.

If your organization needs a different invoicing schedule or if you have any questions, please feel free to connect with Janell Lewis, Director of Leadership Development at jlewis@hanleyleadership.org.

Date*

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