USPS® Leadership 101 Training Registration Form 19 April 2013 Seminar at Lake Murray Power Squadron’s Facility Flotilla Island, 2390 Johnson Marina Road, Chapin, SC 29036 Special Rate at Hyatt Place Columbia/Harbison 1130 Kinley Road, Irmo, South Carolina 29063 Call 1-800-492-8804 or 803-407-1560 and ask for US Power Squad. Rate $82.00 Or use the following link to book online US Power Squad Reservation Link cut off 3rd April Registration 0800 - Workshop 0900 to 1600 Friday including Lunch Please fill out the Registration Form below and return by 22 March 2013 Date:

Last Name First Name Rank Grade

District Squadron Name or Nick Name for the Table Tent

Street Address

City State Zip Code

Certificate No. Current Position or Incoming Position Phone No. Cell No.* (Please provide your email below for acknowledgement of your * Cell Number will only be used in an emergency on Training Day registration and seminar communications)

eMail Address - Any dietary If Yes, please explain. restrictions? No Yes

The Board of Directors has determined that, effective February 2013, all students will be charged $99.00 for each class. Thanks to D/26 who has arranged to offer the training at Lake Murray PS, the fee for this course will be $75.00 for all students. D/26 has also arranged to reimburse their members who successfully complete this course. I am sending a check for $75.00 payable to D26 Leadership Training Seminars to D/C Edwin G. Kridler, SN to cover the costs of printing, coffee breaks, lunch and facilitator travel expenses. All registrations must be received by Friday, 22 March 2013. If we do not have at least 15 students registered by this date the seminar will be cancelled and all registrants will be contacted by email. Because of the short registration time, complete and save this document and attach to an email to D/C Edwin G. Kridler at [email protected] Make sure you select read receipt when sending your email. Then print the registration form and mail it along with check payment to: D/C Edwin G. Kridler, SN Home: 843-762-3986 912 White Point Blvd. Cell: 843-870-5342 Charleston, SC 29412 Email: [email protected] If you don’t receive a registration confirmation email from [email protected] - please call D/C Edwin G. Kridler at the numbers above. The Leadership Development Committee is currently applying for Continuing Professional Education (CPE) certification for these classes. We hope that it will be applied retroactively to January 2013 in which case you will receive a certificate for each of the three courses you have completed in 2013.

Form date: 1 March 2013