Complete and Return This Form to Kaylynn Sullivan Twotrees ()

APPLICATION FORM

Complete and return this form to Kaylynn Sullivan TwoTrees ().

Name______________________________________________________

Address____________________________________________________

City/State/Zip_______________________________________________

Email______________________________________________________

Day Phone____________________Evening Phone___________________

Date of Birth____________________Gender: _________

What attracts you to this experience?

What are your growing edges or key questions pertaining to learning, leadership, and change?

What generative experiences, gifts or knowledge would you bring to this learning community?

What expectations do you have for this experience?

I understand that if enrolled I will attend the entire 5-day program and a non-refundable $250 enrollment fee is needed immediately upon acceptance to confirm my place in the program. The full registration fee of $995 is due by June 1, 2013.

Signature____________________________________Date______________