The Art and Science of Leadership: Driving Results for Donation and Transplantation Professionals
May 5 - November 13, 2025
Full Name
*
First Name
Last Name
Title
*
Professional Education/ Background (RN, MD, other, etc.)
*
Organization:
*
E-mail
*
example@example.com
Mobile #
*
-
Area Code
Phone Number
How many years have you worked in the OPO community?
*
1 - 3 years
3 - 5 years
More than 5 years
How many years have you been in a leadership position?
*
Less than 1 year
1 - 3 years
3 - 5 years
More than 5 years
How many years have you been in your current position?
*
1 - 3 years
3 - 5 years
More than 5 years
Do you have any prior formal business education?
*
Yes
No
If yes, please explain.
Have you ever been involved in a formal coaching / mentor relationship at work?
*
Yes
No
If yes, please explain.
If you have been involved in a formal coaching / mentor relationship at work, how would you rate your experience?
Excellent
Very Good
Good
Fair
Poor
Why did you give the above rating?
What are the top three traits you look for in a mentor?
*
What are your main reasons for participating in The Art and Science of Leadership program (select 3):
*
To help my organization grow and succeed by increasing my management skills and strategic perspective.
To be seen as a leader in my organization and to be prepared to take on additional responsibilities.
To explore the skills and roles required for a successful donation program and the interpersonal leadership competencies.
To develop teamwork and collaboration strategies.
To promote the implementation and assessment of continuous quality improvement in order to increase organ and tissue donation.
Other
Do you have any dietary restrictions?
*
Yes
No
If yes, please explain:
Supervisor's Name
*
Supervisor's Email
*
example@example.com
Are you ABTC or CPTC certified?
*
Yes
No
Are you a donor family member?
Yes
No
Are you a recipient?
Yes
No
If, during the course of the program, we need to send you a package, please let us know where to send it.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Terms and Conditions
Notice of cancellation must be received by Gift of Life Institute in writing, by mail, telecopy (833-784-8283) or at nmuwwakkil@giftoflifeinstitute.org. Cancellations received by April 18, 2025 will be assessed a $600.00 reservation and processing fee. No refund will be granted for cancellations received after April 18, 2025. Substitutions are permitted at the discretion of Gift of Life Institute. Gift of Life Institute reserves the right, at its discretion to cancel the training and will notify the registered participant. Registration fees paid by the registrant to Gift of Life Institute will be refunded, without penalty, or may be applied toward a future Institute training at the discretion of the registered participant.
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Payment Method
*
Credit Card
Purchase Order
Please 'register' to confirm your participation.
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