Applications must be received by the Okmulgee Chamber of Commerce no later than Wednesday, August 30, 2017. All selected applicants will be notified of acceptance by Wednesday, September 6, 2017.

Name *
Name
Address *
Address
Phone/Cell *
Phone/Cell
Address
Address
Phone *
Phone
The following information is not required but is requested to help diversity in each class.
Date of Birth
Date of Birth
Gender
Race
Employment
Employment record (in reverse chronological order)
Organizations and Activities
Please list, in order of importance to you, up to five community, civic profession, business, religious, athletic, and other organizations of which you are or have been a member
Education
begin with high school, then college(s), business or trade schools, and/or other specialized training.
References
please give us reference that will attest to your leadership, and community commitment. (Examples: business leader, community leader, or leadership alumnus.)
Commitment *
Leadership Okmulgee APPLICATION AND COMMITMENT I understand that Leadership Okmulgee is planned to be a learning experience and requires the following commitment on my part: 1. The tuition fee is $350.00 and is to be paid upon acceptance as a participant unless other arrangements have been made. 2. No more than two absences are permitted. An absence at orientation or graduation will result in elimination from the program. There will be no exceptions and no refunds of tuition fee. A graduation plaque will be presented to those who complete the program by fulfilling the above commitments. Graduates of Leadership Okmulgee become vital links in Okmulgee's community service network. I agree to volunteer my time, energy, and skills in future years. I understand the purpose of the Leadership Okmulgee Program, and that completion of this application does not ensure acceptance in Class IX. If selected to participate, I will devote the time required. I understand the above commitments and agree to be bound by them in signing this application.