Us. June 26+27, 2022

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

I'm so glad you're planning to register for the Us. event! Below you'll find all the details about the event, as well as the form to complete your registration. Please email Mickey (mickey@plusoneleadership.com) if you have any additional questions. If you need some help with language to request for district payment for your registration, reach out to Mickey.

ABOUT Us.
Us. is a small event focused on powerful, transformative conversation to inform and deepen our understanding of the impact of gender relations in our leadership work. Space is limited to 20 participants and will reach full registration quickly.

REGISTRATION
Please submit your intent to attend the June 26+27, 2022 Us. event at the Marconi Center by completing this form. Submitting the intent to attend is a commitment to attend the event. An invoice and additional event details will be sent to you once this information is received. Registration closes on June 1, 2022. Contact Mickey if it is past June 1 to see if there is still space.

COST
$650 per person if registration is completed by 5.13.22; $720 thereafter. The cost includes 3 meals, and overnight single occupancy lodging, a copy of the book Atlas of the Heart, and a reflection journal.

MEALS
Registration includes 3 delicious meals. Accommodations for special or restricted diets are available - see below.

PARKING
Abundant on-site parking will be available. Address and directions will be provided at registration.

Attendee Information

Name of Attendee *

Which Date will you be Attending? *

FULL! June 26-27, 2022 (Beginning at 4:00 pm on the 26th; Closing at 3:00 pm on the 27th)

June 27-28, 2022 (Beginning at 4:00 pm on the 27th; Closing at 3:00 pm on the 28th)

Email Address *

Cell Phone *

District / Site / Agency *

Special Requests *

Confirmation of Intent to Attend

Attendance and Payment Commitment *

I agree to pay the full registration fee ($720, or $650 if registered by 4/30/22), which is due upon receipt of invoice. I understand that cancellations received by May 27, 2022 will receive a 75% refund, and cancellations received after 5/20/22 will not be eligible for a refund and full payment is expected.

Required

Payment

Please provide information on payment below.

Who will be responsible for payment of the applicable registration fee? If an individual is paying, directions on how to pay will be sent upon registration. *

Who should the invoice be sent to? Please provide NAME and EMAIL. *

Special Meal Requests

When possible, we try to accommodate special dietary restrictions. Please check ALL boxes below that apply to you.

Dietary Restrictions

Vegetarian

Vegan

Gluten Free

Dairy Free

Other:

If you have food allergies, please list those allergies here:

Comments/Questions?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of PlusONE Leadership.

Does this form look suspicious? Report

Forms