Change Leadership Group Registration

Please note that registration preference is given to teams.


Personal Information
Salutation
^* First Name
Middle Name
^* Last Name
^* Title

Work Contact Information
^* Institution Name
^* Address 1
Address 2
^* City
^* State		if other
^* Country
^* Zip or Postal Code
Work Number
^* Work Fax
^* Work Email

Home Contact Information
^* Address 1
Address 2
^* City
^* State		if other
^* Country
^* Zip or Postal Code
Phone Number
Email

Mailing
^* Preferred Mailing Address		Home Work

Please tell us how you heard about The Change Leadership Group.

^*Mail Codes		Brochure/mailing CLG web site PPE web site Advertisement in educational publication Colleague Attended another program at Harvard Other

Would you like to receive news about future CLG programs? Yes No

If yes, how would you prefer to hear about us? Email Regular Mail

School District Summary
Work Setting		Elementary Middle School High School District-Wide

District Size		Under 2,500 2,500 - 9,999 10,000 - 24,999 25,000 +

School Type		Public Private Parochial

District Setting		Urban Suburban Rural

Program Information
Program Date
November 7-9, 2007

Program Fee

$895 per participant. Full payment must be received prior to the start of the program. You may submit a purchase order or write a check to "Harvard University" and mail to CLG, 8 Story Street, 1st Fl, Cambridge, MA 02138. See web site for cancellation policy.


Payment Method
^* check Purchase Order

(Please note that we cannot accept credit card payments.)

Change Leadership Group - 8 Story St., 1st Floor, Cambridge MA, 02138 - P: 617-496-6702 F: 617-496-3609- Contact US