LEAD Derby Application

Apply to be a participant in the 2017 LEAD Derby class!
Work Address
To help us prepare for your participation in LEAD Derby...
I am aware of the time requirements for LEAD Derby and will attend all scheduled sessions.
My employer has approved my absence from work as required by the Lead Derby program.
Format: M/d/yyyy
Upon submission, Mark Staats will email you to you confirm your application. If you do not receive an email within 24 hours, please re-submit your application or contact the Chamber at (316) 788-3421 or mark@derbychamber.com
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