Leadership Garner Application Leadership Garner Application ($700 tuition for members, $900 for non-members)DEADLINE TO REGISTER - JUNE 3, 2025 AT 5PM First Name * Last Name * Contact phone number * Contact Email * Address Line 1 * Address Line 2 City * State * Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC Zip/Postal Code * Company/Organization Name (if applicable) Title/Position (if applicable) Please list any current volunteer roles you hold in the community, including Board Positions Please provide a brief bio * Why are you applying to the Leadership Garner Program? Please include 2-3 goals or outcomes you'd like to accomplish/realize during your time in the program. * If you could identify one issue area in Garner where you would like to make a lasting difference, what would that be? Why? * What has been your most personally meaningful civic or community engagement? Why? * Multiple Choice * I will be paying for the program My employer will be paying for me I consent and authorize Leadership Garner to use my likeness in any photograph, video or other digital media (“Photos”) taken or to be taken during the course of the Program, in any and all of its publications. I authorize Leadership Garner to edit, copy, enhance, crop or otherwise alter any Photo for use in their publications. I waive any rights for approval or inspection of any Photos. I acknowledge that I am not entitled to any compensation or royalties with respect to the use of the Photos. I have carefully read and fully understand the provisions of this consent form. * I agree I do not agree
