PURC Leadership Workshop: Practicing Leadership in a Political Environment Public Utility Research Center PURC Leadership Workshop: Practicing Leadership in a Political Environment PURC Leadership Workshop Step 1 of 3 - Personal Information 0% Sunday, October 17, 2021 9:00 am - 4:00 pm Gainesville, Florida Application for Admission Please fill out all fields on the form below, or fill out the print-friendly application instead. By providing information on this application, you agree to receive emails from PURC. You may unsubscribe at any time. PURC does not share or sell your contact information. Title*-please select-Mr.Ms.Mrs.MissFirst Name/Given* Last Name/Family/Surname* Working Title* Organization/Dept.* Email* Enter Email Confirm Email Website Phone*include city and country codeFaxinclude city and country codeMailing Address* Street AddressCity* CityState / Province / Region State / Province / RegionZip / Postal Code Zip / Postal CodeCountry*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountry Years of professional experience in regulatory issues* Years of Professional Experience in Management* Emergency Contact*NamePhoneEmail Dietary Restrictions/Food Allergies Payment The registration fee for the PURC Leadership Workshop is US $595 for 48th PURC/WB International Training Program participants. For all others, the registration fee for the workshop is US $695. The registration fee includes tuition, workshop material in English, reading material, lunch, and morning and afternoon snacks. You will be informed on the status of your application within six business days. Accepted workshop applicants will receive further information regarding the payment of course fees, hotel accommodation, other logistical arrangements, etc. Please remember that seating is limited and that proof of payment is due on or before Friday, September 10, 2021. Payment Policy*If accepted to participate at this course, proof of payment will be due on or before September 10, 2021. I have read and understand the payment policy. CancellationCancellation Policy*Cancellation requests must be made in writing via email (email@example.com) or via fax at (+1) 352-392-7796. A 20% cancellation fee will apply to all requests for refunds received on or before Friday, September 17, 2021. After September 17, 2021, no refunds will be granted. Qualified substitutions are permitted. I have read and understand the cancellation policy. Services for Persons with DisabilitiesIf you have a disability and may require accommodations in order to fully participate, please contact us via email (firstname.lastname@example.org) or phone us at (+1) 352-392-6148 at least 1 week prior to the beginning of the event. SubmitPlease press the Submit button only once to avoid multiple applications. You will receive a confirmation email after you submit your information.NameThis field is for validation purposes and should be left unchanged.