Leader Workout Group Application Step 1 of 4 25% About YouFirst Name:* Last Name:* Address Address Line 1 Address Line 2 City* City State* AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code ZIP Code Mobile Phone*Alternative PhoneEmail* Your Leadership Role (Individual contributors are leaders too.)*Company/OrganizationTitleNumber of ReportsDescribe your role (List at least 3 key responsibilities)*What do you enjoy most about your role?*What do you find most challenging?*Will your supervisor be involved in your progress?* Yes No Supervisor's Name First Last Supervisor's Email Your AspirationsHow would you like to grow as a leader?*What is holding you back?*What do you hope to gain from the Leader Workout Group experience?* PreferencesWhat time do you prefer for your workout?* Morning Mid-Day Late Afternoon/Early Evening NameThis field is for validation purposes and should be left unchanged.
