Elevated Leadership Academy

Enrollment Form

Professional Information

Background & Affiliations

Accommodations & Health Information

Emergency Contact

Professional Information

Participant Profile for Program Promotions

To help participants connect with one another and the wider community, the program may feature participant profiles on social media and promotional materials. Please provide:

Media & Testimonial Release

I give the program organizers unrestricted permission to take and use my name, testimonial, biographical data, and/or publish, reproduce, edit, exhibit, display, or copyright photos, videos, or recordings of me in any media format (print, digital, broadcast, etc.) for lawful program-related purposes.

I waive the right to inspect or approve the final product. I understand that program sessions may be recorded and consent to the use of my image, voice, and likeness in those recordings.

Program Participation & Expectations

Commitment Acknowledgment

I understand and commit to participating fully. This includes:

• Day-long program sessions

• Active participation in between session activities

Payment Information

Tuition & Deposit

• Total Program Tuition: $1000

• A $400 deposit is required to secure your place in the program.

• Payment can be made via credit card.

  
  

Alternative Payment Methods:

• If you elect to pay only the deposit at the time of enrollment, Elevated Leadership Academy will issue an installment agreement requiring three consecutive monthly payments of $200 each, totaling the remaining balance of $600.