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Register for Ki ThoughtBridge Events

Inner Work Institute Application Form

COST OF THE INSTITUTE
Before September 16th $3,500.00
After September 16th $4,500.00
(Includes training manual, materials, CD and meals.)

SESSION OVERVIEW
One, Four-Day Experience - November 2-5, 2010
Payment is due upon completion of the application; Payments can be made by credit card (Mastercard, Visa, American Express, and Discover) or by check. For credit card payments, Vincent Smith, Business Manager at Ki ThoughtBridge will contact you to process the payment. For payments made by check please make payable to Ki ThoughtBridge and mail to Ki ThoughtBridge, Attn: Vincent Smith, 135 N. Pennsylvania St., Ste 1750, Indianapolis, IN 46204.

Please fill in the application below and hit submit when completed. You may also view a pdf version of the application and send back to Vincent Smith, Ki ThoughtBridge Business Manager, at vsmith@kithoughtbridge.com or by fax at 317.822.8219.

Name:
Company:
Position:
Length of time in present position:
Phone: ( ) -
E-Mail Address:
Address:
Country:

State:
ZIP Code:
Payment by check:
Payment by credit card:
Describe your current responsibilities:
Previous Management Positions:
Education:Institution Name/Degree Earned/Graduation Year:
Education:Institution Name/Degree Earned/Graduation Year:
Education:Institution Name/Degree Earned/Graduation Year:
Significant Continuing Education and Professional Development Experiences:
Special Honors and Awards:
How do you characterize your leadership?:
What leadership skills do you want to strengthen?:
What are the major changes your organization/industry is facing?:
What challenges do these changes pose for you as a leader?:
Identify a long-term leadership challenge you would like to work on during the Institute:
What do you expect this training to provide?:
What would make this a successful experience?:
Have you participated in other leadership development programs within your organization or outside of the organization? If so, please identify these programs:
What else would you like us to know at this time?:

"These are very important tools which come into play so often in our professional organization."

- Negotiation Workshop Participant
Sovereign Bank


Name:

Company:

Position:

Length of time in present position:

Phone:		( ) -

E-Mail Address:

Address:

Country:

State:

ZIP Code:

Payment by check:

Payment by credit card:

Describe your current responsibilities:

Previous Management Positions:

Education:Institution Name/Degree Earned/Graduation Year:

Education:Institution Name/Degree Earned/Graduation Year:

Education:Institution Name/Degree Earned/Graduation Year:

Significant Continuing Education and Professional Development Experiences:

Special Honors and Awards:

How do you characterize your leadership?:

What leadership skills do you want to strengthen?:

What are the major changes your organization/industry is facing?:

What challenges do these changes pose for you as a leader?:

Identify a long-term leadership challenge you would like to work on during the Institute:

What do you expect this training to provide?:

What would make this a successful experience?:

Have you participated in other leadership development programs within your organization or outside of the organization? If so, please identify these programs:

What else would you like us to know at this time?: