Registration/Payment Form

The Art & Science of 21st Century Leadership & Systems of Care – Springfield, Illinois, November 9 & 10 or Burlington, Vermont, November 16 & 17, 2010. Submitting Your Registration Form: Please complete and submit your registration form on-line. Provide your contact information as you wish it to appear on the participant roster (no acronyms, please). If registration and payment needs to be sent through the mail, send to:

Center for Community Leadership
P.O. Box 3069
Burlington, VT 05408-3069

Cost:
Two Days - $195.00
One Day - $125.00
Registration is guaranteed once payment is received and credited.

The Art & Science of 21st Century

Both Leadership and System Change AND Systems of Care $195.00 Leadership and System Change $125.00 Systems of Care $125.00

Attending in Which State?: Springfield,IL Burlington, VT Prefix: First Name: Last Name: Organization/Company: Position: Office Phone: Email: Mailing Address: City: State: Zip Code:

Special Assistance Requirements: Please tell us if you have any needs requiring specific aids or services, such as wheelchair accessibility or dietary restrictions. All information obtained on this registration form will be used solely for the purposes of the The Art & Science of 21st Century Leadership and System Change & Systems of Care and its parent organization the Center for Community Leadership and will not be sold or used by any outside individual or organization.

Accommodations and Logistics

The Art & Science of 21st Century Leadership & Systems of Care
November 9 & November 10 – Springfield, Illinois - TBA
November 16 & November 17 – Main Street Landing Performing Arts Center, Corner of Lake and College Street on Burlington’s Waterfront, 60 Lake Street, Burlington, Vermont

One day – Cost $125.00 Two days – Cost $195.00 – Covers the cost of the two day seminar and materials.

Pay Online
Please register by completing and submitting the registration form above and paying on-line.
Pay by Check
Please print this page and fill out the form. Please send in the complete form with your check and mail to:
Center for Community Leadership
P.O. Box 3069
Burlington, VT 05408-3069

For more information, call 802-863-9132
Participants are responsible for coordinating and paying for their own accommodations, meals and transportation. We are available for consultations around these items for best prices.

More Information on Accomodations

P.O. Box 3069, Burlington, VT 05408 · ph: 802-863-9132