First Name *

Last Name *

Professional Email (type none if not applicable) *

Personal Email (type none if not applicable) *

Preferred Email Listed *

Enter required value Email 1 - Professional Email 2 - Personal Both

I completed the Signature Program (10 month cohort for Executives) *

Enter required value Yes No

Signature Class # *

(Write no if you ONLY completed the Spotlight Program)

I completed the Spotlight Program (6 week program for Young Professionals) *

Enter required value Yes No

I want to join a Planning Committee for Leadership Stark County’s 40th Anniversary Celebration. *

Enter required value Yes No

Comments/Notes (optional):