ABD Registration - Upstream Academy

To register on-line, fill out the form below. If you prefer to email or fax a form, you can also download a form.

Contact Information
Participant Name
Required
Preferred Name (i.e,. Bill instead of William, etc.)

Firm
Required
Title / Position
Required
E-mail Address
RequiredInvalid Format
Address1
Required
Address 2

City / State or Province
Required Required
Zip / Country (XXXXX-XXXX)
Required
Phone (XXX-XXX-XXXX)
RequiredInvalid Format
Invalid Format Web Site (www.mycompany.com)
Required

Biographical Information for the Participant Binder
Brief Bio (under 50 words) or fill in the fields below and Upstream staff will create a bio based on your information. This bio will be used in the participant binder available to all Academy for Business Development participants.

Areas of Technical Expertise

Industry Specialties

College Alma Mater

Year You Began Public Practice

Hobbies / Interests / Little Known Facts

Firm Contacts

Guide - If you do not yet have a guide, please leave these areas blank and inform Upstream when this individual has been identified. The first guide call will be held in July, so please be sure to provide Upstream with contact information for your guide by this date.
Guide position description.

Guide Name

Guide Email
Invalid Format
Guide Title

Guide Address (if different than participant address)

Firm Management – Indicate the Managing Partner, CEO or other person in the top firm management position.

Managing Partner / CEO Name

Managing Partner / CEO Email
Invalid Format
Managing Partner / CEO Title

Managing Partner / CEO Address (if different than participant address)

Business Development Workshop Attendance

RequiredPlease mark your calendar. All workshops will run from 2pm on day one to 12noon on day two.
Summer 2012 • June 20-21, 2012 • Park City, Utah
Winter 2013 • January 8-9, 2013 • Las Vegas, Nevada
Summer 2013 • June 5-6, 2013 • San Antonio, Texas

Photo
Photo to be used in the participant binder. Your head and shoulders photo should be printable at a minimum of 2 X 2.75 inches (we will crop as necessary). If you are not able to attach a photo to this application, please email one to georgiac@upstreamacademy.com by June 1.

Pricing Information

This price includes the full 18-month program and registration at all three Business Development Workshops.
UAN Member $4,000
Non-UAN Member: $5,000 Required

Payment Information
Check to follow - please mail to P. O. Box 1147, Helena, MT 59624
Pay by MasterCard or Visa Required (After sumitting this form, you will be redirected to a secure site to enter your credit card information)

I have read and agreed to the Academy for Business Development Commitment Required