Registration

Registration Fee ($75.00)

Name

Middle Name

Hebrew Name

Date of Birth

Years in Charlotte

Spouse Name

Child Name

Home Phone Number

Cell Phone Number

Address

City, State and ZIP Code

Business Title

Business Name

Business Address

City, State and ZIP Code

Education

Religious Education

Community Involvement

Work Experience

How did you hear about BLG

What do you hope to gain from participating in BLG?

How do you define leadership? What skills and qualities do you posses, both personally and professionally, that make you an effective leader and strong team player?

We’d like to learn a bit more about you. Describe any special interests, hobbies, or other interesting information you would like to share about yourself.

Describe a leader whom you admire and how he/she has influenced your desire to participate in BLG. The leader can be historic, contemporary, personal or Biblical. Please limit responses to 2,000 characters.

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COMMITMENT

By submitting this form, I am agreeing to the goals and commitments of the Bernstein Leadership Group (BLG):

If selected, I will attend all the sessions/functions and devote the time necessary to be a contributing member of the class. I understand that if I fail to meet these obligations, I may be asked to withdraw from the program.
BLG is a 7-month commitment, running June 2021-January 2022, with sessions held twice a month (typically on Sundays, from 4:00-5:15 pm).
To ensure a meaningful interaction and the creation of a cohesive group, participants are expected to maintain active participation in the program and make every effort to attend each session. You are allowed no more than three excused absences.
BLG is an interactive, hands-on program, and participants are required to prepare a class presentation and do preparatory reading when assigned.
BLG is a leadership program which is guided and informed by Jewish values. As future leaders, BLG participants are asked to fulfil the obligation of Tzedakah (Giving Charity) and personally make a meaningful gift to the Jewish Federation’s annual campaign, which benefits the entire Charlotte Jewish community
Thanks to the generosity of Don and Bobbi Bernstein, BLG is offered to participants at a subsidized cost. A $75 nonrefundable registration fee is due upon application for BLG. The fee helps cover the cost of supplies and program delivery.

Photo Release Waiver

I hereby grant permission to the Jewish Federation of Greater Charlotte and its beneficiary agencies to use photographs or other images in my likeness for any and all Jewish Federation of Greater Charlotte marketing and promotional materials.

Billing Information

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