Elevate Registration

Company

This field is for validation purposes and should be left unchanged.

I am a returning Elevate member*

Yes - returning (no need to update my information)

Yes - returning (but I need to update my information)

No - first time Elevate member

Name

Please enter your name*

Prefix First Middle Last Suffix

Job Title*

Work Email*

Enter Email Confirm Email

Personal Email*

Enter Email Confirm Email

Current Industry*

Dietary Restrictions*

If none, type "none."

Special Accommodations*

Nursing mothers, wheelchair accessibility, etc. If none, type "none."

Demographics

Diversity is an important part of our mission. In an effort to understand our applicants and ensure all populations are served, we have a few questions we'd like to ask. Please know that:
- This information is used to collect demographic data on our applicants.
- The information will not be used for a discriminatory purpose.
- Only Leadership Louisville Center staff and the selection committee will have access to this information.
- Your responses will be kept private and secure.

Date of Birth*

MM/DD/YYYY

Gender*

Gender Notes (optional)

If you selected, "I prefer to self-identify," please do so in this field.

Preferred Pronouns (optional)

If you provide pronouns, they will appear on your permanent nametag. For example: "She/her/hers", "He/him/his", "They/them", "Ze/zir/zirs"

Race/Ethnicity*

Are you a veteran of the U.S. armed forces?*

Do you identify as part of the LGBTQ+ community?*

Are you Foreign Born?*

If foreign born, what is your country of origin?

My Hometown*

Commitments

Executive Women’s Connector Conference – May 19-21, 2027*

Yes, I'm planning to attend and already registered

Yes, I'm planning to attend and haven't registered yet - please send me the link

No, I'm not planning to attend

Mentoring in the Alice Houston Women’s Leadership Program (mentoring is a requirement for the first year of ELEVATE membership)*

Yes, I'd like to Mentor

No, I mentored last year and I'd like to take a break

No, I mentored last year but please let me know if you're short on Mentors

Indicate what is important to you in a mentor/mentee relationship:

What am I best able to teach a Mentee?*

What do I most want to learn from a Mentee?*

Committees*

Yes, I'd like to participate on a committee this year

No, I don't want to participate on a committee this year

Committee Selection

Recruitment Committee: Responsible for evaluating and recruiting new members to the ELC on an annual basis, ensuring a diverse and dynamic membership base. Additionally working with the LLC staff for recruitment & selection of the Alice Houston Program.

Mentor Committee: Composed of experienced ELC members who will lead the ELC’s mentoring initiatives, including the recruitment and selection of mentors to participants of the Alice Houston Leadership Program. Mentors are not required to be members of the ELC.

Programming Committee: Focused on organizing and coordinating events, including, but not limited to, an annual meeting/retreat, that promote networking, relationship building, and professional development among the ELC members.

100 Wise Women Committee: Responsible for suggesting speakers & table hosts for the annual 100 Wise Women series.

WELL Circles

WELL Circles are included in your ELEVATE membership - let us curate a small peer group for you to grow connections deeper!

What’s a WELL Circle?

For women leaders, a WELL Circle offers a vital space to connect with peers who understand the unique challenges they face, offering a confidential environment to discuss life’s complexities and enhance leadership skills. They are your personal board of directors. The deep bonds formed within these groups translate into greater resilience, creativity, and problem-solving abilities—qualities that directly benefit your organizations.

In a WELL Circle you will also:

* Receive monthly development content to facilitate deep discussions centered around the most recent data and breakthroughs in women's leadership
* Connect with a wider community of women leaders through quarterly WELL Empower Hour in-person events
* Learn from amazing thought leaders and an Annual Dinner to network with all WELL Circle members

I would like to participate in a WELL Circle*

Yes - I want to maintain my current WELL Circle

Yes - I'd like to be placed in a new WELL Circle

No thank you

Number of years in a management role:*

How many direct reports do you currently manage in your role?*

This question will ensure you are placed in the most beneficial peer group.

What is the total number of individuals who report up to your position?*

How big is your business' playing field?*

I am looking for:*

Financial Committment

Please tell us below your financial commitment amount*

$2,500

$1,000

I would like to discuss my donation

Important - Please Read!

Please follow this link to pay by credit card or request an invoice.
Please return here to submit this form.

If you'd like to be invoiced for your $1000 gift, please use the promo code "INVOICE" after you add your payment to the cart.

https://join.leadershiplouisville.org/event/elevate-council-2027/e830080/register/new/select-tickets

Important - Please Read!

Please follow this link to pay by credit card or request an invoice.
Please return here to submit this form.

If you'd like to be invoiced for your $2500 gift, please use the promo code "INVOICE" after you add your payment to the cart.

https://join.leadershiplouisville.org/event/elevate-council-2027/e830080/register/new/select-tickets

Important - Please Read!

Please reach out to Jennifer Stevens at jstevens@leadershiplouisville.org to discuss your commitment

After clicking the Submit button, it may take a few moments to process your form. Once your registration is complete, you will see a confirmation message and receive an email within five minutes that contains all the information you submitted. If you do not see this in your inbox, please check your junk folder. If you have any problem with this application, contact Jo Lloyd Triplett at (502) 753-6502.

CAPTCHA

Elevate Registration:

Elevate 2027

Name

Demographics

Commitments

Indicate what is important to you in a mentor/mentee relationship:

WELL Circles

Financial Committment

Important - Please Read!

Important - Please Read!

Important - Please Read!