Apply Now Applying For? Select a programLeadership Coaching3 day program on 'Creating BIG' (July 2020)11 month 'The CEO Program' (July 2020) 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 YesNo 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.