ADVANCED
HAVASU LEADERSHIP
DEVELOPMENT
Sponsored by the LakeHavasu Area Chamber of Commerce
The Mission:Advanced Havasu Leadership Development is a comprehensive leadership program designed to provide Havasu Leadership Development graduates with additional opportunities to refresh, enhance and deepen their leadership skills.
The Vision: Advanced Havasu Leadership Development will provide opportunities for sharing new ideas and developing talents to meet our mission.
CONFIDENTIAL APPLICATION FOR APPOINTMENT
INSTRUCTIONS
Type or print in black ink. Please complete each section fully. Limit answers to the space available. Application must be signed by both applicant and employer/sponsor and returned no later than Aug. 8, 2012.
SELECTION CRITERIA
To graduate fromAdvancedHavasu Leadership Development applicants must participate in the AHLD Orientation Session on Wednesday, Aug. 8, and in the four issue days scheduled in Lake Havasu City and in one of the two out of town sessions. The AHLD graduation certificate is available to those who have successfully completed Havasu Leadership Development. A maximum of twenty individuals will be appointed to participate in the full program. Tuition of $595 includes breakfast and lunch along with the program during the 4 local issue days; participants will be required to cover their own costs for lodging and some meals on the out of town issue days.
The four issue days scheduled in Lake Havasu City will also be open to the general membership of the Lake Havasu Area Chamber of Commerce at an ala carte rate. Ala carte participants will be responsible for a program fee plus meals. The two out of town issue days are open only to program certificate participants.
Applicants for the certificate program must have the full support of the organization or corporation they represent. Attendance at each session is mandatory and is monitored. Those who fail to attend and miss more than two sessions may be asked to withdraw, with no refund of tuition.
Completed Applications should be mailed or delivered to:
LakeHavasu Area Chamber of Commerce
Attn: Lisa Krueger
314 London Bridge Road
Lake Havasu City, AZ 86403
Tel: (928) 855-4115
Fax: (928) 680-0010
e-mail:
ADVANCED HAVASU LEADERSHIP DEVELOPMENT
A program of the LakeHavasu Area Chamber of Commerce
CONFIDENTIAL APPLICATION FOR APPOINTMENT
- PERSONAL DATA
Name:______Date:______
LastFirstMI
First Name or Nickname Preferred:______
Home Address: ______
StreetCityState Zip Code
Employer:______
Business Address:______
StreetCityState Zip Code
Which address would you like to receive mail for this class? ____Home ____Work
Home Phone:______Business Phone:______
E-mail Address:______Fax Number:______
Employer’s E-mail Address: ______
Special Dietary Requests: ______
- EDUCATION
Beginning with high school, please list school, degree(s), and/or specialized training:
Name/Location of SchoolDates (from/to)Degree(s)Major/Course of Study
______
- EMPLOYMENT
Present Employer:______
Supervisor’s Name & Title:______
Supervisor’s Email: ______
Type of Organization:______
Current Position Held:______Since:______
Job Responsibilities:______
List previous employment in reverse chronological order (including active military duty):
EmployerTitle/ResponsibilityFromTo
______
- GENERAL INFORMATION
It is a requirement that applicants have already completed the Havasu Leadership Development program. To better aid us in planning the sessions, please answer the following:
A.What year did you graduate Havasu Leadership Development? ______
B. In reflecting on your experience with Havasu Leadership Development, what about the class did you find most valuable?
______
C. Why do you want to be a part of the Advanced class?
______
D. What are your expectations? What to you hope to gain from this experience?
______
- COMMITMENT
To graduate from Advanced Havasu Leadership Development, a participant is expected to attend all sessions and attendance is monitored. Attendance commitment is as follows:
2012-2013 ADVANCED HAVASU LEADERSHIPDEVELOPMENT PROGRAM SCHEDULE
Each month’s program will include a Leadership Component and the Topics noted below. The classes are not limited, however, to just the topics listed below. Continental breakfast and lunch is provided at each full day session.
Aug 8, 2012:Orientation @ Lake Havasu Area Chamber of Commerce Conference Room, 5:30 – 7 p.m.
Aug 15, 2012:Communication Skills: Toxic People, Decontaminate Difficult People at Work Without Using Guns or Duct Tape
Guest Speaker Marsha Petrie Sue is the Muhammad Ali of communicators, especially in dealing with difficult people. She can dance and look pretty, and she uses the entire ring, but she knows how and when to land a knockout punch. Think of her presentations as charm school with live ammunition. Also known as The Accountability Master, Marsha dares people to take personal responsibility for their choices, success, and life. She is original, unique, and a one-of-a-kind professional speaker and author.
Location: Lake Havasu Association of Realtors, 2293 Swanson Ave, 7:30 a.m. – 5 p.m.
Sep 14 & 15, 2012:NAU Challenge Course:
This overnight session will be held at the New Northern Arizona University Challenge Course in Flagstaff, AZ, and will include two team-building sessions; day one is low-ropes challenges; day two is high-ropes. Participants are responsible for lunch and dinner on day 1; and hotel/motel room charge (approximately $115 – sharing rooms is encouraged to reduce individual costs). Lunch is included on day 2 prior to leaving Flagstaff to travel home to Lake Havasu City.
Nov 4 & 5, 2012:The Building of a Town:
This is an overnight session at Stagecoach Trails Guest Ranch in
Yucca thatcontains an exercise to create a mock city government. The focus will be on skills required of leaders such as responsibilities and liabilities of council members, ethics and the impact of city government decisions on the community. Participants will enjoy the western flair of the Ranch and enjoy home-cooked meals and a guided horseback trail ride. Participants will be responsible for the overnight lodging/meals fee (approximately $110 per person).
Jan 9, 2013:CTL-ALT-DELETE: Rebooting the Workplace for Success
This session’s focus is on managing change in the workplace. It will include solutions, ideas, and activities that will have an immediate impact on how your leadership role can create a positive outcome. Guest Speaker Holly Duckworth, CMP, CAE is the President and Chief Connections Officer of Leadership Solutions International. Holly is a high energy, dynamic, and quality focused association management professional and professional speaker with more than 10 years of experience. She delivers organizational excellence by building quality business strategic planning, communications, and member educational opportunities to drive business results. Location to be announced.
Mar 7, 2013:Effective Human Relations:
This session provides a basic overview of the components for creating and sustaining a positive employee relations climate. The session explores the elements of an effective employee relations program, effective coaching, counseling and progressive discipline strategies and effective communication techniques. Guest speaker Marnie Green is a leading expert in the management of public sector employees. Her book, Painless Performance Evaluations, is used worldwide by federal, state, and local government leaders. Location to be announced.
Apr 10, 2013:Time Management:
This session will provide techniques to maximize effectiveness, beat work overload, better manage your time and achieve your goals. Following the day’s session, certificate program participants will celebrate the completion of Advanced Havasu Leadership Development with a small ceremony including a champagne toast and light hors d’oeuvres. Location to be announced.
I understand the purposes of the Advanced Havasu Leadership Developmentand I will devote the time and resources necessary to complete the program. Even though emergencies do arise, I understand that any participant missing more than two sessions for whatever reason, may be asked to withdraw from the program and no portion of the tuition shall be refunded. I also understand my tuition payment is due and payable at the time this application is submitted to the Chamber unless I make other payment arrangements. If for any reason my application is not accepted by the Chamber, I understand that my tuition payment will be refunded.
As a part of this program I grant the Chamber of Commerce permission to use any photographs and/or testimonials as it deems appropriate.
By signing below, I understand the above commitments and agree to be bound by them.
______
Applicant SignatureDate
EMPLOYER COMMITMENT AND VERIFICATION
This application has been approved by our organization and the applicant has our full support, including the time away from work required to participate in the program.
Company Name:______.
I understand that ______, if accepted into the Advanced Havasu
Leadership Development program, is required to attend all sessions of the program and
that they may be withdrawn from the program with no refund of tuition if they miss
more than two sessions. By signing below, I understand the commitments being made by
myself and ______and agree to be bound by them.
(applicant name)
______
Employer Signature and TitleDate
(if different than applicant)
______
Business Telephone Number
TUITION
If accepted into the Advanced Havasu Leadership Development program, you or your employer/sponsor will be expected to submit the tuition, which covers all program costs as indicated earlier in this document with the application. Cost of tuition is $595. Deadline for application submission is August 8, 2012.
Check for payment in full is enclosed
(Please make check payable to Lake Havasu Area Chamber of Commerce)
Is your tuition being paid by your employer/sponsor?YesNo
Is your tuition your personal responsibility?YesNo
Please consider me for scholarship funds.
Scholarship funds are limited and total awards will
be based on the need/number of applicants.
Please charge my credit card:
VISA/MASTERCARD # ______Exp Date ______
Name ______
Signed ______
Lake Havasu Area Chamber of Commerce
Advanced Havasu Leadership Development
Indemnification Form
INITIALS (everyone must initial)
I, ______, being eighteen (18) years of age or more and a member of the Advanced Havasu Leadership Development program, acknowledge that I have chosen to participate in the Leadership Development sessions paid for by myself and/or my employer.
I further acknowledge that as with all activities, the potential exists for personalinjury to me. Injury could include but is by no means limited to sprains, strains, brokenbones, burns, lacerations, concussion, paralysis and even death.
I am not now, nor will I be under the influence of, consume any alcohol or anychemical substance during the program. I am also responsible for my own actions atgroup dinners and networking activities following any/all training sessions.
I have decided to participate in this program, or segments of the program, and inconsideration of being accepted into the program, I hereby waive and release all rightsand claims which I may have against the Lake Havasu Area Chamber of Commerce, its board, members, employees and agents for any and all injuries or damages suffered by me in participation in this program.
I understand that the Lake Havasu Area Chamber of Commerce does not providemedical coverage if I am injured while participating in this program. Any medicalcost incurred as a result of my participation will be my responsibility to pay.
______
Print full name
______
SignatureDate
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