City of Miami Beach

LEADERSHIP REGISTRATION

Use this form to register for the Leadership Academy.

NOTICE: Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to the City of Miami Beach.

* Required Field
*Name:   
*Address:   
*Home Phone:   
Work Phone:
Fax:
E-mail:
Occupation:
Homeowner's Association / Affiliation / Organization:
List your Community Activities:
Briefly explain why you wish to enroll in the City's Neighborhood Leadership Academy:
Gender:

Ethnicity:






Ethnicity Other:
Education Level:






Education Other:


For additional information, please contact the City Manager's office at 305.673.7010