2018 SF-CESS Equity-Based I-Group Facilitator Training Application*
*Acceptance is based on completion of this application and the readiness as indicated in some of the answers.
Participant Last Name *
Your answer
Participant First Name *
Your answer
Title *
Email *
(to send pre-training materials)
Your answer
Phone *
(to use if we need to contact participant about any major changes)
Your answer
Organization *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Q1: Why do you want to attend SF-CESS' Equity-Based iGroup Facilitator Training? *
Your answer
Q2: What work have you done personally and professionally that prepares you to facilitate equity centered, transformational collaboration with others? *
Your answer
Demographic Information (for planning purposes)
Gender *
How do you identify?
Your answer
Race *
How do you identify?
Your answer
Role *
Diet Restrictions *
We will work with our caterers to maximize meeting reasonable dietary needs; we cannot accommodate individual orders. Depending on the specificity of your needs, you may want to bring foods you know you will be able to eat.
Logistics and Payment
To ensure a smooth application and registration process, please fill out each of the fields below with the most accurate information available to you. If you have questions or are unsure how to answer, call SF-CESS at 415.992.5007 or email us at thecenter@sfcess.org. Full payment is due prior to the first day of the seminar.
For which week do you wish to register? *
*If you are able to attend either week, please check both and we will place you in the week based on numbers and demographics
Required
Attendance Requirement Acknowledgement *
Required
Registration Type *
Please choose the registration type that fits your circumstance. PLEASE NOTE: If payment is not made by the due date, all discounts will be voided. Dependent on payment date, standard late fees may by applied
Payment *
How will you pay? Full payment is due prior to the first day of the seminar.
Who is responsible for payment? *
Check if address for billing is same as the address provided above
Payment Contact Information
If your organization is providing payment on your behalf, please provide the billing contact information below.
Billing Contact Name
Your answer
Email
Your answer
Phone
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
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