LEAD Bourbon County Referral Form - Fort Scott Area Chamber of Commerce, KS

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LEAD Bourbon County Referral Form

LEAD Bourbon County is a program organized by the Fort Scott Area Chamber of Commerce designed to develop and engage the leadership skills of potential and current leaders through exposing participants to diverse aspects of our local community. Resources of the KLC (Kansas Leadership Center) are utilized for the curriculum as well as guest speakers which often include a tour of a local business or community attraction. The program will run September 2017 through May 2018. We highly recommend the program and appreciate referrals.
Date and Time
Format: M/d/yyyy

Your Name (Person Referring a LEAD Bourbon County Participant)

First Name *

Last Name *

Are you a graduate of LEAD Bourbon County, or the former Bourbon County Leadership Program?

Yes No

Your Contact Phone *

Your Contact Email *

Name of Person You are Referring to the LEAD Bourbon County Program

First Name *

Last Name *

Phone Number of Referral Candidate *

Email of Referral Candidate *

Business or organization with which the candidate is currently affiliated/employed, or note if an Individual or Retired *

Occupation of Referral, unless an Individual/Retired *

Please state briefly why you feel the referral would be a good candidate for LEAD Bourbon County. *

Do we have your permission to use your name when contacting the referral? *

Yes No
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