Advanced Leadership Program: Module 1

FLEXIBLE CREDIT REIMBURSEMENT REQUEST

Email Address*	email
	(If you are requesting reimbursement on behalf of someone else, please enter that person's email address in this field)

CC Email Address	ccemail
	(The email address of a person who should be copied on all event emails to this registrant, if needed)

I (the registrant) consent to United Way Worldwide's collection of my personal data for the purpose of providing event-related services and communications, and permit UWW to share this data with UWW employees, event registrants, and certain other third parties, pursuant to UWW’s privacy policy for conferences.unitedway.org.*

* = Required Field

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If you experience any issues, please contact Ask United Way.