Event Details:

The Advanced Leadership Seminar is a 5 day event focused on breakthrough. The Samurai Game is played on Thursday evening of the event.

Facilitator Training & Certification Application

Name*

First

Last
Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Work Phone*
Mobile Phone
Home Phone
Email*
Website
Tell us about your work…
Your Occupation*
Company Name
Company Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
What is your position with this company?
Years with the company?
What does the company do?
Tell us about your experience and interest in The Samurai Game®…
How many times have you played The Samurai Game®?*

Please note that you must have participated in at least one The Samurai Game® in order to enter the Facilitator Training & Certification Program.
Please list the Date, Facilitator's name and Location of each Samurai Game® you've attended:*
For what purpose do you desire to be trained and certified to facilitate The Samurai Game®?*
At this point, whom do you expect to serve when you are a Facilitator of The Samurai Game®?*
If certified, approximately how frequently would you anticipate facilitating The Samurai Game®?*
Tell us about your personal or professional experience that may be relevant to your successful facilitation of The Samurai Game®…
Describe your experience facilitating group processes and/or experiential education:*
Other thoughts you'd like to share with us?
Please provide names, email and phone numbers of three professional references:
#1*

Name Email Phone
#2*

Name Email Phone
#3*

Name Email Phone
Which Facilitator Training & Certification (FTC) program are you interested in?
Select the FTC program of interest:*
- Tepoztlan, Mexico: March 9-20, 2020
Please upload your current resume or bio:*
Drop files here or

Max. file size: 128 MB.
Maximum file size: 250 MB
Please upload a current photo of yourself (headshot)*
Max. file size: 128 MB.

Maximum filesize: 250 MB
Please click “Submit” below. We will review your application and get back to you within 3 business days. Once your application has been accepted, you will receive an invoice and payment instructions to reserve your space in an upcoming Facilitator Training & Certification program. Thank you for your interest in becoming a certified Facilitator of The Samurai Game®!

Date/Time
Date(s) - 10/20/2024 - 10/26/2024
All Day

Primary Contact Number

Email for Participant Registration
info@samuraigame.org

Participant Fee

Location
Location not given, United States

The Advanced Leadership Seminar is a 5 day event focused on breakthrough. The Samurai Game is played on Thursday evening of the event.

Facilitator Training & Certification Application

Name*

First

Last
Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Work Phone*
Mobile Phone
Home Phone
Email*
Website
Tell us about your work…
Your Occupation*
Company Name
Company Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
What is your position with this company?
Years with the company?
What does the company do?
Tell us about your experience and interest in The Samurai Game®…
How many times have you played The Samurai Game®?*

Please note that you must have participated in at least one The Samurai Game® in order to enter the Facilitator Training & Certification Program.
Please list the Date, Facilitator's name and Location of each Samurai Game® you've attended:*
For what purpose do you desire to be trained and certified to facilitate The Samurai Game®?*
At this point, whom do you expect to serve when you are a Facilitator of The Samurai Game®?*
If certified, approximately how frequently would you anticipate facilitating The Samurai Game®?*
Tell us about your personal or professional experience that may be relevant to your successful facilitation of The Samurai Game®…
Describe your experience facilitating group processes and/or experiential education:*
Other thoughts you'd like to share with us?
Please provide names, email and phone numbers of three professional references:
#1*

Name Email Phone
#2*

Name Email Phone
#3*

Name Email Phone
Which Facilitator Training & Certification (FTC) program are you interested in?
Select the FTC program of interest:*
- Tepoztlan, Mexico: March 9-20, 2020
Please upload your current resume or bio:*
Drop files here or

Max. file size: 128 MB.
Maximum file size: 250 MB
Please upload a current photo of yourself (headshot)*
Max. file size: 128 MB.

Maximum filesize: 250 MB
Please click “Submit” below. We will review your application and get back to you within 3 business days. Once your application has been accepted, you will receive an invoice and payment instructions to reserve your space in an upcoming Facilitator Training & Certification program. Thank you for your interest in becoming a certified Facilitator of The Samurai Game®!

Name	Email	Phone

Name	Email	Phone

Name	Email	Phone

Name	Email	Phone

Event Details:

Facilitator Training & Certification Application

Tell us about your work…

Tell us about your experience and interest in The Samurai Game®…

Tell us about your personal or professional experience that may be relevant to your successful facilitation of The Samurai Game®…

Please provide names, email and phone numbers of three professional references:

Which Facilitator Training & Certification (FTC) program are you interested in?

Facilitator Training & Certification Application

Tell us about your work…

Tell us about your experience and interest in The Samurai Game®…

Tell us about your personal or professional experience that may be relevant to your successful facilitation of The Samurai Game®…

Please provide names, email and phone numbers of three professional references:

Which Facilitator Training & Certification (FTC) program are you interested in?