Bregman Leadership Intensive Application

Name
First Last
Email Address*
Company*
Title*
Preferred Phone*
What do you hope will be different after you attend the Bregman Leadership Intensive?*
How might you get in the way of your own learning during the Intensive?*
What else should we know about you?*
Please acknowledge the date and price by checking the box below*
- I have checked the dates (10/20 – 10/25), the location (Connecticut), and the cost ($9,995) and I am able to attend.
A copy of your responses will be emailed to the address you provided.