Over the five-session program, Executive Orientation participants get to know one another over shared meals, as well as becoming connected to key regional stakeholders. By discovering more about the Greater Hartford community, they discover new ways to appreciate their leadership role within it. And through the long-established network represented by their fellow Leadership Greater Hartford program participants, they can find thousands of reasons to continue building on their accomplishments.

Executive Orientation Enrollment Form

Step 1 of 5

Name
First Last
Title:
Company:
Department:
Work Address:
Street Address Address Line 2 City State ZIP Code
Work Phone:
Cell Phone:
Work Email:
Home Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Email:
Assistant’s Name:
First Last
Assistant’s Email:
Assistant’s Phone:

RELEASE AND WAIVER OF LIABILITY

1. I hereby give Leadership Greater Hartford and those acting under its permission or upon its authority (herein referred to as “LGH”), with respect to statements, images, photographs, film, or recordings in whatever manner (herein referred to as “Work”) provided by or taken of me by or on behalf of LGH, the unrestricted right to reproduce, distribute, and/or otherwise use any still or moving photographic image, likeness, or sound recording of me as obtained in or through an LGH project or activity.

2. I hereby grant LGH the right to display, exhibit, distribute, transmit or broadcast the Work by any means now known or hereafter to become known, including, without limitation, on LGH ‘s Website. I hereby waive all rights of inspection or approval with regard to any Work.

3. I hereby release, discharge and agree to hold harmless LGH, and any of its employees or agents, from and against any and all liability to me or any third parties resulting from their use of my name and the Work.

4. I agree that there shall be no LGH obligation to utilize the work granted by me. The terms of this release and waiver shall commence on the date below and be without limitation.

5. I authorize the publication of my name and contact information in LGH rosters and directories.

6. I warrant and represent that I am over the age of 18 years and that I have read this release and know the contents and that I am signing as my own free act and deed.
Name:
First Last
Date:
MM slash DD slash YYYY
Signature Required - RELEASE AND WAIVER OF LIABILITY
Thank you for completing this application. We will contact you regarding your status.

Greg Andrews
Director
Executive Orientation Program
860-206-7018
greg.andrews@leadershipgh.org