Rising Leaders Academy Commitment PAge - Patti Perez

Personal Contact Information

Please enter information for the person who will be enrolling in the Rising Leaders Academy.

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title/Role*

Organization Billing Information

Please enter the billing information for the organization sponsoring the enrollee. An invoice will be emailed to you within 1-3 business days. If you are an individual who plans to pay for this program out of pocket PLEASE email info@persuasionpoint.com. We highly encourage first asking your employer to sponsor you and we can help you facilitate that process.

Organization Name

Organization Contact Name

First Last

Organization Contact Phone

Organization Contact Email

Organization Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Selected Program

PO or any other additional payment information.

Your Commitment*

I commit to personal and professional DEI development.

By submitting this form you are committing to doing the work, both as an organization and/or as an individual. The work includes making the time and space to show up to the live calls, taking advantage of the online community support, and completing any homework to help you and your organization achieve DEI success through the Rising Leaders Academy coaching programs.

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Rising Leaders Academy Commitment

Personal Contact Information

Organization Billing Information

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