Leadership Skills for Success Registration First Name Last Name Company Job Title Address Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code If you are a New York State employee, please indicate which NY County you work in: - Select -AlbanyAlleganyBronxBroomeCattaraugusCayugaChautauquaChemungChenangoClintonColumbiaCortlandDelawareDutchessErieEssexFranklinFultonGeneseeGreeneHamiltonHerkimerJeffersonKingsLewisLivingstonMadisonMonroeMontgomeryNassauNew YorkNiagraOneidaOnondagaOntarioOrangeOrleansOswegoOtsegoPutnamQueensRensselaerRichmondRocklandSt. LawrenceSaratogaSchenectadySchoharieSchuylerSenecaSteubenSuffolkSullivanTiogaTompkinsUlsterWarrenWashingtonWayneWestchesterWyomingYates Phone Number Email Email Confirm email How did you hear about our workshop(s)? How did you hear about our workshop(s)? - Select -CatalogCheese Market NewsCheese ReporterCornell University websiteCourse announcementDair-E-NewsDairy Foods Extension websiteDairy Foods MagazineFood Quality MagazineFrom my company or coworkerIDFANewsletterNortheast Dairy Foods AssociationWord of mouthOther… Enter other… Please choose the business sector that best describes your role: - None -Federal RegulatoryState RegulatoryIndustryEducation Select course date: June 15-18, 2021 Course Registration Fee Flat Fee: $850 Payment is completed on the confirmation page. Received and accepted registrations imply commitment to fees and to limited space. Out-of-state fees higher due to New York State funding. Payment Type Credit Card Invoiced Payment* *Invoiced payment are for special circumstances only. Please contact Louise Felker at email@example.com. Deadline: Registrations & Payments must be received by June 1, 2021. This course is limited to the first 25 registrants. Confirmation: Upon receipt of registration, you will receive an automatic e-mail confirming your registration form has been received and a payment link for credit card payment. Once you receive the payment link, fill out all required information and click “submit.” You should receive a receipt of payment by e-mail within minutes. Once payment is received, confirmation of attendance will be sent by Cornell Staff via e-mail; unpaid spots will be released to others. Cancellation Policy: No refunds can be given if not canceled by COB on June 1, 2021. Substitute registrants are accepted at any time.