LT NEXT CONFIRMATION

Congratulations! You have been chosen as a member of Class XI of Leadership Tennessee NEXT.

To confirm participation in Class XI of Leadership Tennessee, the below form must be submitted by June 16th. We will send invoices for payments beginning in July of 2025. Program fees are due to Leadership Tennessee by August 1st, 2025.

Please don't hesitate to reach out if you have any questions or concerns.

The information provided below will be used by the Leadership Tennessee office and for press releases regarding the Leadership Tennessee NEXT program and participants.

LT NEXT
CONFIRMATION

Preferred First Name

Name to be used on all publications.

Preferred Last Name

Preferred Email

This will be the email that Leadership Tennessee will use to share all program details. Please be sure to include an email that you check regularly.

Preferred Phone

(###)

###

####

Preferred Street Address

City

State

Zip Code

County

Region

Where you currently live/ work. Memphis Delta - Shelby, Tipton, Lauderdale, and Fayette counties. Northwest - Lake, Dyer, Obion, Crockett, Gibson, Weakley, Carroll, Henry, and Benton counties. Southwest - Haywood, Madison, Hardeman, Chester, McNairy, Henderson, Hardin, and Decatur counties. Northern Middle - Humphries, Houston, Stewart, Dickson, Montgomery, Cheatham, Williamson, Davidson, Robertson, Rutherford, Wilson, Sumner, and Trousdale counties. Southern Middle - Wayne, Perry, Lawrence, Lewis, Hickman, Giles, Maury, Marshall, Lincoln, Moore, Bedford, Franklin, and Coffee counties. Upper Cumberland - Warren, Cannon, DeKalb, Smith, Macon, Van Buren, White, Putnam, Jackson, Overton, Clay, Pickett, Cumberland, and Fentress counties. Southeast - Marion, Grundy, Sequatchie, Hamilton, Bledsoe, Bradley, Rhea, Meigs, McMinn, and Polk counties. East - Monroe, Loudon, Roane, Morgan, Scott, Blount, Knox, Anderson, Campbell, Sevier, Jefferson, Grainger, Union, Claiborne, Hamblen, and Cooke counties. Northeast - Greene, Hawkins, Hancock, Unicoi, Washington, Sullivan, Carter, and Johnson counties.

Professional Title

Organization

Twitter

Instagram

Dietary Restrictions

T-Shirt Size

Issue Identification (1/3)

Throughout your program year, you will have the opportunity to hear about various topics, issues, and opportunities across the state. Please identify three issues you see as the most pressing issues facing your community and/or the state. Use the next three spaces to indicate those areas.

Issue Identification (2/3)

Issue Identification (3/3)

I confirm my participation in Leadership Tennessee NEXT and thereby agree to devote the time, energy, enthusiasm, and resources necessary to complete the program. I understand that even though emergencies arise, each session is mandatory for completion of the program, unless otherwise permitted by Leadership Tennessee staff. By confirming my participation, I agree to pay the $2,500 program dues by August 1st, 2025, with the understanding that a failure to do so will forfeit my seat in Leadership Tennessee NEXT Class XI.

Date

YYYY

LT NEXT
PROGRAM Dues

Class XI Program Dues - $2,500
Program Dues include lodging and parking fees at hotels, food and travel during sessions, and program related costs.
Program Dues do not include travel to and from session cities, cost of after hours gatherings during sessions, and other non-program related costs.
Scholarship Recipients - your 'balance due' amount will vary. Contact us to arrange payment. Scholarships are limited.
Program fees are due to Leadership Tennessee by August 1st, 2025.
LT NEXT Program Dues are not tax deductible.
Checks can be made to Leadership Tennessee, 718 Thompson Lane, Suite 108-141, Nashville, TN 37204.

LT NEXT CONFIRMATION

The information provided below will be used by the Leadership Tennessee office and for press releases regarding the Leadership Tennessee NEXT program and participants.

LT NEXT CONFIRMATION

LT NEXTPROGRAM Dues

LT NEXT
CONFIRMATION

LT NEXT
PROGRAM Dues