BUSINESS FAMILY DYNAMICS FEB 28 - MAR 1, 2023 | CORPORATE PROGRAM APPLICATION

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LEGAL INFORMATION

PRIVACY NOTIFICATION

COLLECTION AND USE: The personal information you provide to us during this application process is collected and used for purposes relating to the Family Enterprise Advisor (FEA) Program.

EXTERNAL STORAGE: This application process is managed using online service providers. By submitting your application, you are consenting to the collection and storage of your information on servers located in the United States.

Please check the box below to continue

I AGREE

PROGRAM SCHEDULE

February 28 - March 1, 2023

Online, via Zoom

10:00 am to 5:00 pm ET | 7:00 am to 2 pm PT

There will be a one hour nutrition break each day from 1:00-2:00 p.m. ET | 10:00-11:00 a.m. PT plus two short breaks per day in the morning and afternoon.

PERSONAL DETAILS

Title

First Name (e.g. Robert)

Preferred First Name (name by which you are commonly known by, if different from the above e.g. Rob)

Last Name

Gender

How did you hear about us?

Please list your referral (name of person/organization)

Please list the specific conference/event

Other details

PROFESSIONAL DETAILS

Current Job Title (enter unemployed if currently not working)

Organization Name (enter Independent if you do not have an organization name)

Portion of Practice Involving Families in Business

Primary Area of Practice (select one choice)

Additional Area of Practice (select one choice)

Website

E-mail

Alternate E-mail

Employer Address Line 1

Employer Address Line 2

Employer Address Line 3

Employer City

Employer Province/State

Employer Postal/Zip Code

Employer Country

Telephone (Please include extension if applicable)

Mobile Phone

BILLING INFORMATION
Please specify how you would like invoices to be made out if different from previous.

Billing Organization Name

Billing Address Line 1

Billing Address Line 2

Billing City

Billing Province/State

Billing Postal Code/Zip Code

Billing Country

E-Mail Address of Billing Contact

Telephone Number of Billing Contact (include extension if applicable)

DESIGNATIONS

Please select the number of designations you have

Designation 1

Abbreviation

Full Name of Designation

Conferment Year

Designation 2

Abbreviation

Full Name of Designation

Conferment Year

Designation 3

Abbreviation

Full Name of Designation

Conferment Year

Designation 4

Abbreviation

Full Name of Designation

Conferment Year

Designation 5

Abbreviation

Full Name of Designation

Conferment Year

ADDITIONAL TRAINING OR PROFESSIONAL CERTIFICATIONS

Please select the number of certifications you have

Certification 1

Full Name