Roundtable Network Assembly Registration - due 9/28
Our amazing Jewish Social Justice network will come together in November 2017 for our Network Assembly! We are really looking forward to it.

The Network Assembly is from November 14-16 in Maryland. Here are details: http://jewishsocialjustice.org/network-assembly-2017

Member organizations can send up to 4 staff members, and ally organizations can send up to 2. It is up to each organization to make the decision about who should participate, based on the goals of the Assembly (which can be found at the link above).


Although this form is due 9/28, we are asking you to register earlier so we can plan our program accordingly (with YOU in mind!).

Things you’ll need before you begin this registration form:
-Your 3-5 sentence bio
-Any roommate request you might have
-A headshot of you for our program (don't worry too much about this - we will crop if the picture isn't perfect)

And be in touch with questions or thoughts! Email Hannah at hannah@jewishsocialjustice.org

Your Info
Organization Name
Your answer
First Name (as you'd like it to appear on your nametag)
Your answer
Last Name (as you'd like it to appear on your nametag)
Your answer
Title
Your answer
Email
Your answer
Work phone number
Your answer
Cell phone number
Your answer
3-5 sentence bio (as you would like it to appear in the program)
Your answer
Please submit a headshot of you for us to use in our program by 9/28! (But why not do it now so we don't have to follow up?) Please upload one here: https://www.dropbox.com/request/TW7gIrwU6LHP8Xwvt6JE
(Don't work too hard on this - it doesn't have to be perfect, we will crop if there are others in the picture)
Any food allergies? Pearlstone is a certified Kosher and vegetarian facility. Leave blank if none apply.
What are your preferred gender pronouns?
She her and hers, he him and his, they them and theirs, or others.
Your answer
How do you identify racially?
This question is optional and will help us plan for our racial justice training with the full group in mind
Your answer
How do you identify religiously?
Many, not all, of the Roundtable individuals are Jewish, and we want to make sure we take everyone's identities into account as we plan.
Your answer
Housing and Cost
The program & housing fee per person is $100-195 TOTAL (not per night). The Roundtable is covering all food, programming, and housing fees above that.

We will collect payment via check. By 9/28, you will have your organization send a check based on this process:

(This is all on jewishsocialjustice.org/network-assembly-2017)

>> Calculate your organization’s payment to the Roundtable based on the lodging of each individual attendee.
Orchard guest rooms - $195 per person
Cabins and lodges - $150 per person
Commuter rate (staying at a hotel) - $100 per person

>> Checks for your organization's attendees should be made payable to Bend the Arc (our fiscal sponsor) and sent to:
Jewish Social Justice Roundtable
℅ Bend the Arc
330 7th Ave, 19th Floor
New York, NY 10001
Please write "JSJR Network Assembly" in the memo.

Ideally your organization will pay with one check for all of the attendees, total.

If your organization cannot pay by check, please get in touch with hannah@jewishsocialjustice.org

See jewishsocialjustice.org/network-assembly-2017 for an invoice should your organization need it.

Make sense? (Send any Qs to hannah@jewishsocialjustice.org)
Which housing option would you like? Please read carefully, as your program fee depends on which you choose.
All rooms are first come first served, unless you need an ADA compliant room. See here for more details and photos about each style of housing at Pearlstone: http://pearlstonecenter.org/retreat/accommodations/
Any roommate requests?
We don't have the list of all attendees yet, of course, but if you know of someone(s) who is attending and you both want to room together, please share that here. We cannot guarantee that this request will be met if you do not mutually request each other and if you do not select the same room type at registration.
Your answer
Do you need an ADA Compliant room?
Travel
The Roundtable has a travel stipend fund to enable everyone interested in coming to do so - even from far away. That said, if organizations can cover their own travel costs, that is VERY appreciated!

We are keeping our program costs low by subsidizing the Network Assembly, so it's helpful if your organization can cover your travel costs.

If you choose to ask for a transportation stipend, the Roundtable will reimburse transportation costs to the following limits:
California/Colorado: $450
Midwest: $300
Boston: $250
Philly: $150
DC: $50
New York: $150

Because of this, it’s in your best interest to purchase travel as early as possible before prices go up!

Details about travel can be found at jewishsocialjustice.org/network-assembly-2017. If you are arriving by train, the closest station is Penn Station - Baltimore. If you are arriving by plane, the closest airport is BWI Thurgood Marshall Airport.

Where are you traveling from?
Your answer
Will you request a travel subsidy?
Please see jewishsocialjustice.org/network-assembly-2017 for details about this process.
Communities of Practice
Which of these communities of practice would you like to be in based on your primary role in your organization?
Please pick your first choice community of practice
Please pick your second choice community of practice
This is in case we do not have critical mass for a COP and need to cut your first choice.
Racial Justice Add on Day
We will have an optional Racial Justice Community of Practice add-on training day starting after lunch on November 16th through lunch on Friday, November 17th. This is for a subset of you who are actively working on racial justice (both internally in and externally to the organizations).

Topics may include: Building relationships and partnerships with organizations of color, voting rights work, criminal justice work, delving into the unique Jewish contribution to racial justice, developing our own racial justice stories and identifying what history or cultural patterns get in our way.

Will you join us at the Racial Justice Community of Practice Day on November 17th?
Thank you so much! If you would like to request childcare, please continue below. Otherwise, scroll down and click "submit." Can't wait to see you in November!
Childcare
The Roundtable is committed to helping the parents of young children in our network attend the gathering. While the Network Assembly has no family oriented programming, we will help organize childcare for parents who would not be able to participate unless your children accompany you. Cost and method of childcare will be determined by how many request it.Children will not be able to participate in sessions and workshops, but are welcome to join parents at meals, breaks, and after the programming ends each day.
Do you plan on bringing your child/children with you to the Network Assembly?
Number of children
Your answer
Age of children
Your answer
Special needs for your children
Your answer
Anything else we should know?
Your answer
By clicking "submit" you have OFFICIALLY registered for the Network Assembly!
Submit
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