Purpose Centered Club Executive Program
Please provide a response to each of the following questions:
1. First & Last Name
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2. Title/Position{"type":"text","name":"__generic2","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
3. Club/Employer (or enter N/A)
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4. Upon completion of the PCCE program, is there anyone in your organization (i.e., Club President, General Manager, Committee Chair, Director, etc.) with whom you would like us to share your accomplishment? If so, list the Name, Title, and Email Address of the person you wish to receive notification of your achievement. (or enter N/A)
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5. Please list your current professional certification(s), and if appropriate, your level of certification(s).
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6. In which areas of your life (personal and/or professional ), and to what degree, do you experience a low sense of personal fulfillment ?
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7. In which areas of your life (personal and/or professional), and to what degree, do you feel out of alignment with your faith and values ?
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8. How did you learn about the PCCE Program?
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9. What are some of the reasons that you want to participate in the PCCE Program?
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10. Which one specific change in your life do you intend to change as a result of your participation in the PCCE Certificate Program?
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TERMS & CONDITIONS:
Upon completion and review of my Application, I understand that I am being granted 1 of only 30 available participant seats. I understand and agree that the program registration fee being paid with this application is non-refundable. I agree that immediately upon being notified of my application being received and accepted, I will complete my registration process as directed in the email I receive acknowledging my acceptance into the program. I agree to pay the balance of my program fee in the manner indicated by my selection below: Please select just one of the options :
- Option A: A single payment of the remaining balance by check or credit card. - Option B: (5) equal monthly payments, by credit card, beginning on June 1st. - Option C: One partial single payment made by your employer and one partial single payment by you, in amounts that you may choose, by June 1st. {"type":"radio","name":"__generic6","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"- Option A: A single payment of the remaining balance by check or credit card.\n- Option B: (5) equal monthly payments, by credit card, beginning on June 1st.\n- Option C: One partial single payment made by your employer and one partial single payment by you, in amounts that you may choose, by June 1st."} (Enter Your Name & Click Submit to Complete Your Application)
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