Leadership During Crisis - Boot Camp : Registration Form

Leadership During Crisis - Bandung Boot Camp

( Registration Form )

CONFIDENTIAL QUESTIONNAIRE

Welcome to your Leadership During Crisis - Boot Camp. You are about to embark on an extraordinary journey. One in which you will be personally guided by Arthur F. Carmazzi, the principal founder of the science of “Directive Communication” to harness the power to revolutionize your POWER AS A LEADER.

The following questionnaire is designed to help us identify your computability and chances for success if you join LEADERSHIP Leadership During Crisis - Boot Camp as well as clarify your Leadership goals. We know that you are high caliber achiever in your field who is committed to doing whatever it takes to make sure you set your outcome so we need your frank opinion in answering this questionnaire. Enjoy the process… If you are selected, your Leadership During Crisis - Boot Camp workshop begins now!

PERSONAL DATA

*First Name : *Last Name:

*Address: *City:

*Province: *PostCode: *Country:

*Phone(H) : Phone (Office):

Fax : *Email :

Date of Birth :(DD/MM/YR) Current age :

Please list the name(s) of any friends or family wishing to attend Leadership During Crisis - Boot Camp with you :

*Name:	*Relationship to you:

*Marital Status:

single in a committed relationship married separated divorced widowed

*Organization you work with:
*Number of years in Organization:
*Position and Level of Responsibility:
*Number of People You Lead:

*Name:

Leadership During Crisis - Boot Camp
(please use additional paper if you run out of space for your answers)

SECTION I: WHY ARE YOU ATTENDING Leadership During Crisis - Boot Camp?

1. What motivated you, or what is your compelling reason, for attending Leadership During Crisis - Boot Camp?

2. What is the one thing you most want to learn, develop, change or reinforce at Leadership During Crisis - Boot Camp?

3. How do you intend to measure your achievement from Leadership During Crisis - Boot Camp?

4. List 3 of your other goals for next 12 months.

SECTION II: HOW PRODUCTIVE IS YOUR ORGANIZATON/TEAM?

5. What is your primary focus in Leadership During Crisis - Boot Camp? Where have you put the time and energy in your organization or team?

6. Please describe 2 events that have shaped the your Leadership Style, and what you learned from them?

Event # 1:

What I learned from this event:

Event # 2:

What I learned from this event:

SECTION III: WHAT LEADERSHIP QUALITIES DO YOU HAVE?

7. Please list 8 (eight) most important qualities in order of significance and elaborate.

	*Most significant:	1.
		2.
		3.
		4.
		5.
		6.
		7.
		8.

8. Which qualities do you most want to improve?

SECTION V: WHAT EMOTIONS, MOTIVATIONS AND SITUATIONS DRIVE YOUR LEADERSHIP DECISIONS?

9. In what areas of your work do you experience the most stress? What creates that stress? (Be specific).

10. How do you get out of stress? What “coping mechanisms” do you use to feel better?

11. What emotions & behavior do you experience on a regular basis that you would like to change/eliminate?

12. What makes you a good leader?

13. If you given a choice, would you revamp your organization? Why and how?

14. What was your BEST leadership Decision? Why?

15. What was your WORST leadership Decision? Why?

SECTION VI: PLEASE TELL US A LITTLE ABOUT YOURSELF:

*Your age: 12-17 18-21 22-29 30-39 40-49 50-59 60-64 65 or older

*Highest Level of Education Completed:

Less than High School High School Jr.College/Trade School

Bachelor′s Degree Postgraduate Study Postgraduate Degree

*Approximate Annual Family Income (US dollars please):

0-$24,999 $25,000-$74,999 $75,000-$149,999

$150,000-$-$249,000 $250,000-$749,000 $750,000+

*Country of Your Principal Residence:

*Why did you commit your time, energy, and resources to attend Leadership During Crisis - Boot Camp? (Please place in sequential order all those that apply, 1 being most important to your decision)

A live presentation by Arthur F. Carmazzi

A conversation with a friend, relative, or associate

A letter/invitation you received from Directive Communication International

A letter/invitation you received from Arthur F Carmazzi

Listening to audio CDs (please list):

A Conversation you had with a DC Franchisee

A brochure you received from Directive Communication International

Other (please describe specifically):

Other comments: