LeadFit Application Form

Candidate Information

First Name^*

required

Last Name^*

required

Employer Name^*

required

Address^*

required

Apt., Suite, Etc.

City^*

required

State^*

required

Zip^*

required

Address is:^*

required

Home

Work

Email^*

required

Phone^*

required

Are you a licensed CPA?^*

required

Yes

If you hold a supervisory position, how many people do you supervise?

Shirt Size^*

required

Men's Large

Men's Small

Men's Medium

Men's X-Large

Women's Large

Women's Small

Women's Medium

Women's X-Large

Please note any dietary restrictions:

Why do you want to attend LeadFit?^*

required

Please attach a current resume/biographical sketch:^*

required

Please include your experience in accounting and work history for the past five years.

Please attach a recent photograph:^*

required

Mentor Information

Keep in mind, your LeadFit mentor will be an important part of your LeadFit experience—and a strong advocate for your growth throughout the program. We recommend selecting a mentor from within your organization who supports the purpose of LeadFit and is positioned to encourage and reinforce your development along the way.

Mentor Name^*

required

Mentor Company Name^*

required

Mentor Email Address^*

required

Mentor Phone^*

required

Billing Contact

Billing Contact Name^*

required

Billing Contact Email Address^*

required

Billing contact street address^*

required

Apt., Suite, Etc.

City^*

required

State^*

required

Zip^*

required

Any questions or additional information you would like to share with the COCPA?

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Member Value

Member Resources

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LeadFit Candidate Application

Candidate Information

Mentor Information

Billing Contact