* 1. Your Name

* 2. Your Organization's Name

* 3. Your e-mail

* 4. Best number to reach you?

* 5. If you are not the main point of contact for this training event, please list the name and contact information for the appropriate contact person at your organization here.

* 6. Please check which core training programs you are interested in from Take The Lead.

* 7. Please check which elective programs are you interested in from Take The Lead.

* 8. What is the approximate size of your group?

* 9. What are your group's greatest leadership development needs right now? Please check up to three selections.

* 10. How did you learn about Take The Lead's training programs?

* 11. In your own words, what would make a Take The Lead workshop or custom training program a success for your team?

* 12. Do you have a Take The Lead Leadership Ambassador (Trainer) you would like to work with? If yes, tell us here. If not, Take The Lead will match you with a Leadership Ambassador based on your team's needs.

* 13. Will you allow Take The Lead to collect data (and share data with you and your organization) on the effectiveness of your Take The Lead training event? (Please note: This data is very useful to Take The Lead in accomplishing Take The Lead's mission of gender parity in leadership across all sectors by 2025, so we thank you for letting us collect data if possible. We will obtain your permission for using your company specific data in any way before sharing with others or sharing publicly).

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