Leadership Mississippi 2022 Acceptance Form August 17, 2021 Please fill out the Leadership Mississippi 2023 Acceptance Form below.First Name* First Last Name* Last Maiden Name Last Title* Company* Phone*Email* Please Review the Acceptance Condition Document Below Leadership Mississippi Class of 2020 Terms & Conditions Acceptance* I agree to attend the sessions included in the acceptance letter unless a demonstration of an extraordinary circumstance prevents me from participating on those dates. I recognize that any unexcused absence or failure to timely comply with the notice requirements of the Excused Absence Policy may constitute a basis for participant removal from the class. I acknowledge that participating in all program activities is solely my own initiative, risk, and responsibility. I agree that Leadership Mississippi may use any media footage with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content. I give this authorization without the expectation of compensation. I agree to ensure the $3,500 Leadership Mississippi program tuition is paid on or before March 22, 2023. Leadership Mississippi Class of 2023 Participation I do not accept the invitation to participate. Reason for DecliningIf you declined above, please list your reason why in this box.Electronic Signature* Full Name Please type your full name into the box above. The entry of your name represents your digital signature; you have read the above terms & conditions, accepted the terms and conditions, and the invitation to participate in the Leadership Mississippi Class of 2023. Share This PageTweet
