Question Title

* 1. First name

Question Title

* 2. Last name

Question Title

* 3. Company

Question Title

* 4. Title

Question Title

* 5. Who is your direct supervisor?

Question Title

* 6. Address

Question Title

* 7. Address 2 (if needed)

Question Title

* 8. City, state, zip

Question Title

* 9. Cell number

Question Title

* 10. Email address

Question Title

* 11. What is your birthday?

Date

Question Title

* 12. Upload your headshot:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

Question Title

* 13. LinkedIn URL:

Question Title

* 14. Were you recommended to apply by a past Leaders Lab participant?

Question Title

* 15. Is your organization a member of the Minnesota Chamber?

Question Title

* 16. What outside organizations have you volunteered or been engaged with and how did you contribute?

Question Title

* 17. In your opinion, what are the three most significant policy issues facing business in the state of Minnesota and why?

Question Title

* 18. You will spend four, two-day sessions as part of a group of 35-40 business leaders from across the state. You will be touring different companies and talking with our state's business and political leaders. What do you expect to gain from this experience?

Question Title

* 19. What previous engagement, if any, have you had with the Minnesota Chamber or local chambers?

Question Title

* 20. Reference/ Referral Name

Question Title

* 21. Title

Question Title

* 22. Company

Question Title

* 23. Phone

Question Title

* 24. Email

Question Title

* 25. I acknowledge the time commitment Leaders Lab will take (four sessions, two days each session) and I have the full support of my employer to participate in this program.

Question Title

* 26. I fully plan to attend the sessions for their duration and do not have any complications known at this time.

T