Mosaic of Peace 2020 Conference in Israel/Palestine: Witnessing for Peace and Wholeness in a Land Called Holy
March 15-28, 2020

CONFERENCE PARTICIPATION REGISTRATION FORM

Please complete one form per person and return to the Presbyterian Peacemaking Program AS SOON AS POSSIBLE. We will send a confirmation of your form’s successful submission.

Email address *
PERSONAL INFORMATION
First Name *
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Last Name *
Your answer
Preferred Phone *
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Is your preferred phone: *
Alternate Phone
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Is your alternate phone:
Mailing Address *
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City *
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State *
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Zip Code *
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Date of Birth (mm/dd/yyyy) *
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Gender *
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CHURCH AFFILIATION
Denomination *
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Church Name *
Your answer
Church Mailing Address *
Your answer
Presbytery/Judicatory *
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What best describes your relationship to the church? Please check all that apply. *
Required
Are you a recent seminary graduate? Please include the name of your seminary and year of graduation, if applicable.
Your answer
NARRATIVE QUESTIONS
Where applicable, please limit your responses to 150 words or less.
Have you ever lived in or visited countries outside the United States? If so, briefly describe your experience, including the countries and dates. *
Your answer
Have you ever traveled to Israel/Palestine? If so, what motivates you to return? If not, what most captivates you about this conference? *
Your answer
Tell us about your experience with peacemaking and your work for peace and justice in your congregation, community, mid-council, or within the larger church. *
Your answer
In what ways do you hope to be inspired, equipped, and connected by taking part in this conference? *
Your answer
What unique gifts and strengths would you bring to the conference? Do you have music, art, writing, social media, photography, worship leadership or other gifts that you would be willing to share? Please explain. *
Your answer
How would you imagine you would return to share your experience and "to take meaningful action for a just and lasting peace in the region?” *
Your answer
What else would you like to share that can help us get to know you? *
Your answer
CONFERENCE PREPARATIONS AND ARRANGEMENTS
The conference includes pre-conference webinars and assigned readings. Are you willing to commit to these? *
The conference involves a moderate level of physical activity, provides a nice variety of regional cuisine and includes simple but comfortable hotel accommodations. Do you have special accommodations or concerns of which we should be aware? *
If yes, please explain:
Your answer
SESSION OR PRESBYTERY/JUDICATORY ENDORSEMENT
Conference participants are expected to have a relationship with a church community, to have the support of the community for the trip, and to share their learning with the community when they return. Please include below the name and contact information of a person who can endorse your participation. We will email that person an endorsement form for their response.
Name of Endorser *
Your answer
In what capacity will this person submit their letter of endorsement? *
E-mail address *
Your answer
Phone *
Your answer
A copy of your responses will be emailed to the address you provided.
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