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Applying For?
Select a programLeadership Coaching3 day program on 'Creating BIG' (July 2020)11 month 'The CEO Program' (July 2020)The Strategy ConversationThe Power Conversation

Full Name

By what name would you like to be called?

Date of Birth

Residence Address

Cell Number

Residence Number

Email Address

Master's degree

University where you did your Master's from

Bachelor's degree

University where you did your Bachelor's from

Any other qualifications

Professional Background

Name of Current Organization

Designation

Number of years in this Organization

Have you been sponsored by your Organization
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Postal Address

Office Number

Email Address

Total years of experience

Your Participation

Please take a moment to complete this section in as much detail as possible. This will help us understand the reason for your participation in the program and help in evaluating your application.

1. What is the reason for your participation in this program (Please elaborate in detail)?

2. What is that you intend to accomplish from this program (Please elaborate in detail)?

3. Is there anything else that you would like to communicate with the program leader (Please elaborate in detail)?

Agreements and Confirmations

Please read this information carefully and completely. By pressing the submit button the end of this form it is understood that you comprehend and agree with the points mentioned herein. If you have any questions, please feel free to contact the once and an authorized person will respond to your questions.

• This is an executive coaching program that puts a demand on the participant. This is done through discussions, voluntary sharing and exercises. The participant confirms that s/he is ready to take on the enquiry and participate in the program the way s/he is meant to participate.
• Fees once paid is not refundable.
• You confirm that you are mentally, physically and emotionally prepared to take on a rigorous program and that you have chosen to attend this program on your own responsibility. You are fully aware of your decision and no one has forcefully enrolled you in this program.
• For you to receive the results of the program, your participation must be an expression of your free choice.
• You indemnify, the Institute for Generative Leadership, a division of Sameer Dua Training LLP and its staff and employees from any and all liabilities arising out of your participation in this program.
• You will ensure confidentiality of the materials, practices and methods adopted in this program by the Institute for Generative Leadership. Also, the program encourages participants to share openly and you agree not to disclose any of the information shared by the co-participants of the program. Staff at the Institute for Generative Leadership and the Program leader in particular will not disclose personal interactions they have had with the participants and will maintain confidentiality.
• The jurisdiction for any disputes will be the Courts of Pune.
• Method of Payment -
  For Cheque / Demand Draft payment, please address in favour of The Institute for Generative Leadership
  For payment by Wire Transfer / NEFT, the bank details are as follows:

  Account Name: The Institute for Generative Leadership
  Bank Name: Cosmos Bank A/c No. : 028100108099
  Branch: Koregaon Park, Pune
  IFSC Code: COSB0000028
  MICR Code: 411164023
  Provisional GST Number of Sameer Dua Training, the holding company of
  The Institute for Generative Leadership is 27ACHFS1770Q1ZF.

• You agree to:

  Be coachable
  Follow the actions plans that are prepared by you and do all the assignments that are provided.
  Fully participate in the program.
  Meet your time commitments.
  Turn off your mobile phone and other distractions during workshops.
  Comply with the Program leader's reasonable directions in the conduct of the Coaching.