FLM 2025-2026 Application

Future Leaders in Motion – Class of 2026

Program Registration Form

General Information

Full Name:
Job Title:
Company Name:
City:
State/Providence:
Office Phone:
Cell Phone:
E-Mail Address:

Tell Us About Yourself

How long have you worked for the company you're with now?:
Do you have any leadership responsibilities?:
If so, how many people do you directly lead?:
Please check the areas in which you have experience.:
Please tell us about your previous work experience:
Job Title:
Industry:
Company Name:
Number of Years Worked:
Job Title:
Industry:
Company Name:
Number of Years Worked:
Briefly Describe:
Why do you want to be considered for the Future Leaders in Motion Program?:
What leadership traits would you like to gain from the program?:
What are a few of your personal strengths?:
What are current growth areas that you want to improve?:

Supervisor Information

FPDA will provide updates to your company on your progress in the FLM program. Please provide the name and contact information of your immediate supervisor:
Name:
Job Title:
Email Address:
Office Phone:
Is there anyone at your company who would be willing to learn about serving the Future Leaders In Motion as a mentor? If so, please provide name, title, and contact information.:

Confirmations & Attestations

Please check that you understand and accept the terms of commitment required of the FLM program.
I understand the time commitment, travel, and pre/post meeting assignments that will be associated with my participation in this program.
I fully agree to actively participate in all scheduled FLM programs. This includes but is not limited to:
Monthly Group Meetings via Teams (1.5 hours per)
Regular Mentor Meetings (1 to 2 timer per month (30-1hour))
3 In-Person Meetings:
October 2025 – Program Kickoff @ FPDA Summit in Greenville, SC
March 2025 – University of Innovative Distribution (Sunday – Thursday)
October 2026 – Program Graduation @ FPDA Summit (location pending)
This program is designed to provide a format in which participants can learn and network with colleagues in an environment of mutual respect. Participants will be always held responsible for their behavior including social activities for in-person programs, that are both sponsored and informal.
Upon receipt of this application, the FLM team will review all applications. Once class selections are made, the direct supervisors will be contacted to verify their support of your participation in the program and confirm the program fee is approved.
Once enrolled, the $5,400 program fee in non-refundable and non-transferable after September 9, 2024. If a mentor is provided by the sponsoring company, there is a $500 discount so the program fee will be $4,900.
Note: Once that attestation is received, you will be invoiced for the program fee. Full payment will be required before you will be formally enrolled in the program.
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