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Strategic Conference for Gamaliel Religious Leaders
Contact information
Prefix
Name
(Required)
First
Last
Pronouns
Email
(Required)
Phone
(Required)
Name of your affiliate organization
(Required)
Emergency contact
Emergency Contact Name
(Required)
First
Last
Emergency Contact Email
(Required)
Emergency Contact Phone
(Required)
Rooming and accommodations
Preferred roommate
Food restrictions or requirements
Accessibility instructions/requests
Travel Plans
I will be flying in for this training
I will be driving myself and bring my car to the event
Photo/Video Release
(Required)
I agree to the following statement.
I hereby grant permission to Gamaliel and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Gamaliel and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview or presentation, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation A acknowledge that I am over 18 years of age.
Signature
(Required)
Payment options
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Pay Now, Early Bird
(Required)
Pay Now
Pay Later
Early Bird Registration fee is $450 per person for double-occupancy. After September 1st, the Registration fee is $500 per person.
Pay Now Standard Rate
(Required)
Pay Now
Pay Later
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Single Room
Yes I would like a single room.
By default all rooms are doubles meaning you are with a roommate. If you would like a single room add +450 (early bird) or $500 (standard rate) to the registration fee.
Payments are due at the beginning of training, payment options will be available on your confirmation email. Questions about payment contact Regina Mahone at 312-357-2639 ext. 102
Total
Billing Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Credit Card
(Required)
Card Details
Cardholder Name
