Home Events Kentucky Family Leadership Academy – April 10th – 12th, 2023 Kentucky Family Leadership Academy – April 10th – 12th, 2023 Kentucky Family Leadership Academy - April 10th - 12th, 2023 "*" indicates required fields Name* First Last Please choose from the following*Attending as a Family Member PeerAttending as an Adult PeerAttending as a Youth PeerProviderBirth Date* Your Email Address:* Street Address* Street Address Address Line 2 City 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 Phone Number* Please select the one that most applies to you:* I am a hired employee and my employer is sending me to this training. I'm not hired and would like to attend this training for myself. I'm going to be hired after completing this training and the Family or Youth Peer Support Certification Training. Other Employing Agency/Organization Name:* If this does not apply to you, please list N/ASupervisors Name (if Applicable)* First Last If this does not apply to you, please list N/ASupervisors Email Address* If this does not apply to you, please list N/AAllow KPFC to use my picture or video for publicity* Yes, I give permission to use my picture or video for publicity No, I would not like KPFC to use my picture or video for publicity Academy Contract* Attend the entire training Participate to the fullest ability Let staff and peers know if I need help or assistance Show respect to facilitators and participants Complete and return all evaluations and surveys to the best of my ability Have fun at the Academy! Please read the contract , check all of the boxes before your registration is complete Leadership Academy Fee Per Person Price: Payment Options*Pay onlinePay by MailSend my employer an invoiceApply for Partial ScholarshipTotal CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. + Add to Google Calendar + iCal / Outlook export Date Apr 10 - 12 2023 Time EST 8:30 am - 4:00 pm Cost $100.00 Share this event
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