Program Commitment and Release Form
Please read, complete electronically (all yellow highlighted sections) and return via e-mail to by Friday, June 1, 2012. (Instructions for returning form are included at the end of the form.)
Two important events launch your Leadership Louisville experience. The orientation reception on June 21, 2011 is the first opportunity to meet your classmates. While attendance at this event is not required, we hope you will be able to attend. The second is the overnight Opening Retreat on August 23-24, which is mandatory in its entirety.
Class Participation (please check one box)
I accept this invitation to participate in Leadership Louisville and will attend the Opening Retreat (in Lexington, KY) on August 23-24 in its entirety.
I will not participate in Leadership Louisville this year.
Orientation Reception (please check one box)
I will attend the Tuesday, June 26 orientation reception at the Leadership Louisville Center.
I am not available to attend the orientation.
Attendance, Tuition and Membership Policies
§ Opening Retreat - Development of a successful leadership class takes time and commitment. You must be with us to become a part of the class and the experience. This begins with the Opening Retreat, which is mandatory in its entirety. A last minute conflict with any portion of the retreat will prevent you from participating in the class this year. You may then re-apply next year.
§ Class Attendance - Your attendance during the eight program days (September-April) and the Closing Retreat (May) will be monitored. Two excused absences are allowed. A third absence will require you to petition the Leadership Louisville Center Board of Directors to review your status. Three consecutive absences result in automatic dismissal.
§ Tuition - Program tuition fees are due in full by June 29, 2012. If you are unable to pay in full by the due date we are required to have an authorized credit card on file.
Before the program begins, the Leadership Louisville Center incurs substantial administrative costs related to your admission. No tuition will be refunded for withdrawal or dismissal from the program after July 16, 2011.
§ Change in Status - Your selection into the Leadership Louisville class was based on a variety of criteria, including the company or organization you represent. Should you change employers between the time of your acceptance and the Opening Retreat in August, the Leadership Louisville Center reserves the right to reconsider and rescind, if necessary, your invitation to participate in the program.
§ Commitment as a Member - Your participation in the class is a privilege that carries the responsibility and expectation of continued involvement with us through the form of annual dues and attendance at events. We also hope we can count on your ongoing word-of-mouth support to promote our programs.
General Release
In consideration of my acceptance for participation in the Leadership Louisville program, I do for myself, my heirs and personal representatives hereby and forever release Leadership Louisville, their officers, employees, affiliates, successors and agents from any and all manner of actions, causes of action, debts, claims, demands or liability for any harm or injury I may sustain arising out of or in any way connected with my participation in the Leadership Louisville program.
I make this release freely, and I acknowledge and assume all risks which may arise out of or may be connected with my participation in the Leadership Louisville program.
Photo Release
The Leadership Louisville Center respects individual privacy and, therefore, must obtain a signed release form from any participant visibly recognizable in the photograph. Crowd scenes where no single person is the dominant feature are exempt.
These rules govern photographs intended for use in any Leadership Louisville Center publication of a marketing or a public relations nature, such as newsletters, brochures, viewbooks, promotional items or other materials. Releases also must be obtained for photographs used on the website. These rules are not in effect when photographs are taken of news events.
I hereby grant the Leadership Louisville Center permission to interview me and/or to use my likeness in photograph(s)/video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by the Leadership Louisville Center, in perpetuity. I will make no monetary or other claim against the Leadership Louisville Center for the use of the interview and/or the photograph(s)/video.
My (typed) signature below indicates my commitment to and understanding of the Leadership Louisville Center attendance, tuition and membership policies. It also indicates my agreement to the general and photo releases.
The TYPED SIGNATURE below will serve as my electronic signature.
(Please do not insert any other type of digital signature.)
(click inside the gray box to enter text)
Printed Full Name / Last 4 digits of SSN / Date
To return the completed form:
Using Microsoft Word 2007 - click the Office Button in the upper-left corner, click Send, then click Email and send to .
Using Microsoft Word 2010 – Click File, next click Save and Send, then click Send using Email, then click Send as Attachment and enter .
To be completed by Leadership Louisville Center staffElectronic Signature Confirmed by:
LLC Staff Member Name / Date
Notes:
Leadership Louisville Commitment and Release Form – Page 1 of 2 Updated: 5/17/2012