2025 Leadership Academy

"*" indicates required fields

Name*

First Last

Current Position/Title:*

Facility/Company:*

Address:*

Street Address City State ZIP Code

Phone:*

Email:*

NAB ID:

All WI NAB IDs start with an "R". Must provide NAB ID to earn NHA CEs.

What is your ultimate career goal?*

Why have you chosen to pursue a career in Long Term Care?*

What are the current challenges you face, personally, as an emerging or existing leader?*

*These should not be organizational challenges but personal challenges.

What knowledge or skills do you hope to acquire as a result of your participation in the leadership academy?*

Tuition*

$1,750

Price reflects the $250 scholarship.

I understand and confirm that payment MUST be received by WHCA/WiCAL in advance of the first session in order to attend and participate in the Academy. Refunds, less a $500.00 processing fee, will be honored if a written request of cancellation is received by jena@whcawical.org before 5 PM CST on April 25, 2025.*

(please enter your initials)

Payment Information:

How Would You Like to Pay?*

Check

Credit Card

Both options will receive an invoice. If you select check, an invoice will be emailed to you from taylor@whcawical.org. If you pay via credit card, confirmation of registration/invoice will be emailed to you when you click Submit.

TOTAL AMOUNT DUE:

Credit Card:*

Card Details

Cardholder Name

Billing Address:*

Street Address Address Line 2 City State ZIP Code

This field is for validation purposes and should be left unchanged.

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