Posted: Monday, June 28, 2010
2010-2011 LEADERSHIP FLORENCE PROGRAM
The Greater Florence Chamber of Commerce
Application - Due Date: June 30, 2010
Name/Title: __________________________________________________________________
Employer: ___________________________________________________________________
Business Address/City/Zip: _____________________________________________________
Work Phone: ____________________ Home Phone: ______________________
Fax: _______________ Cell Phone: ____________________________________
Email: _____________________________________ Gender: ____ Male ____ Female
Educational/Accomplishments/Honors: ____________________________________________________________ ____________________________________________________________
Community activities: __________________________________________________________ ___________________________________________________________
I believe I can make the following contributions to the Greater Florence area:
___________________________________________________________
What I would like to see addressed by the leaders in the Greater Florence area is:
______________________________________________________________
Tuition is $1200. A $200 deposit must accompany this application. The balance ($1000) is due before August 1, 2010 or can be sent with application. Deposits will not be refunded after July 30, 2010.
Have you applied to Leadership Florence before? ____ Yes ____ No
Yes, I can make this attendance commitment, and I have the support of my employer.
I will not hold any member, individual, business or organization associated with The Greater Florence Chamber liable for any injury I might suffer while in route to, from or during training or other official functions.
________________________________________________________________ Date Applicant Signature
_________________________________________________________________
Date Employer/Sponsor Signature
Return with deposit by June 30, 2010
Leadership Florence
POB 948, Florence, SC 29503
843/665-0515 or Fax 843/662-2010
Email: gmadison@flochamber.com
