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ADDRESS: 901 Dulaney Valley Road, Suite 800
Towson, MD 21204
PHONE: 888-481-3500
FOLLOW BLI:
Participant Application
Registration is not complete until after you submit payment during the next step. If you have any questions please email info@BLIonline.org
 
SECTION 1: PERSONAL INFORMATION
First Name
Last Name
Suffix
 
Home Phone
Email
Member ID
Date of Birth
 
Home Address 1
Home Address 2
City
Zip/Post Code
State
 
Work Phone
Firm/Company Name
Work Address 1
Work Address 2
City
Zip/Post Code
State
 
Licensed CPA?YesNo
 
Professional focus (check all that apply)Public AccountingBusiness and IndustryGovernmentNon-profitEducationOther
Firm Size:<1010-4950-200<200
 
 
SECTION 2: EDUCATION
Please specify the highest level attained:BA DegreeMA DegreePhD DegreeOther
 
List leadership positions held, special honors and awards received:
 
 
SECTION 3: WORK INFORMATION
Present job title or position:
Direct supervisor's name:
 
What do you consider your highest career achievement to date?:
 
Employment Record (list most recent first and include employer name, position held, and period of service):
 
Business / Professional Affiliation (list most recent first and include name of group, position held, and period of service):
 
 
SECTION 4: COMMUNITY INVOLVEMENT
Include community, civic, religious, political, social, athletic or other activities. Please include organization name and description of involvement:
 
 
SECTION 5: GENERAL
What do you hope to gain from the BLI Leadership Academy?:
 
What do you think are the most important issues facing the accounting profession and why?:
 
Who is sponsoring you for the Leadership Academy?:
 
 
SECTION 6: COMMITMENT
 
I understand the objectives of the BLI Leadership Academy program and recognize the value of participating. If I am selected, I will devote the time and resources necessary to complete the program to the best of my abilities.
 
 
 
Full Name to be used as Signature:
Date:
 
 
 
Questions? Email info@BLIonline.org or call 888-481-3500
 
 
 
 
Download the 2016 Business Learning Institute Course Catalog DOWNLOAD PDF
Business Learning Institute - Course Catalog
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