Application NameThis field is for validation purposes and should be left unchanged.Name(Required)Go-by name (for name tag):(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Employer(Required)Business Phone(Required)Email(Required) Position, Title, or Rank:(Required)Have you previously applied for the Leadership Wichita Falls Program?(Required) Yes No Why do you want to participate in LWF? (Please check all that apply)(Required) Active Community Involvement Company Requirement Resume Builder Introduction to Volunteer Boards Networking Personal Enrichment Identify three priority issues/areas that you feel require local community attention.(Required)Indicate any volunteer activities you have participated in the last 5 years.(Required)Please list 3 references:(Required)Shirt Size:AcknowledgmentMy employer and I understand the time commitment required by the Leadership Wichita Falls Program, and if I am selected, I will devote the time required. 100% attendance at all sessions is expected to complete the Leadership program. I understand that this program includes group transportation and group activities that may require some physical participation. I hereby agree, as indicated by my signature below, to hold Leadership Wichita Falls harmless in the event of injury.Typing your name acknowledges the above statement(Required)Tuition InformationTuition for the LWF program is $695. Tuition costs are usually paid by the participants’ organizations. However, individual payment is also accepted. The complete tuition must accompany the application and will be promptly returned if not selected for the class. Refunds will not be available after January 2.Payment Type(Required) Check Credit Card You’ll be redirected to place a Credit Card Payment after application submission. Mail Check To: Leadership Wichita Falls P.O. Box 8344 Wichita Falls, TX 76307
