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CONTACT INFORMATION
School Name / Organization
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Name of Registration Contact
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This person will be contacted with questions about participants or registration information.
Registration Contact Day Phone #
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(include area code)
Registration Contact Email Address
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PARTICIPATION INFORMATION
Name
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What name does the participant go by?
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(example William = Bill, Kathleen = Kathy
Registration Options*
Select ALL sessions for which the head will participate.
Marc Frankel: October 15; 3-4:30 pm EST
Virtual Happy Hour: October 15; 5-6 pm EST
Hot Topics & Closing Worship: October 16; 11am-12:30pm EST
Participant "Weather/Travel/Tech Emergency" contact/cell number:
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(In case of last minute cancellations, lateness, travel advisories, or tech issues) Cell phone preferred
What is the participant's E-mail address?
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Topic Suggestions/Hot Topic Ideas
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Please share any information here
Please send a confirmation email to the address below*: