Educator Information
Thank you for being attending the Seeds of Change Conference 2021 as a participant! Please take the time to fill out this form so we have your information.
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Email *
Preferred First Name *
Last Name *
School or Organization Name *
Title or Grade Level/Subject Taught *
Which parts of the conference day do you plan to attend?
Which breakout room would you like to be in for the "Intergenerational Dialogue and Coalition Building by Topic" session from 1:00 - 2:15pm?
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Are you willing to facilitate any portion of the event if we need extra facilitators? We will facilitation materials and training, if needed.
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I grant to Chatham University, its representatives and/or employees the right to take videos, audio recordings and/or photographs of me during the time of my participation and/or my organization’s involvement in a Eden Hall K-12 Program Social Justice and Sustainability Series panel event. I also authorize Chatham University, its assignees and transferees to copyright, use and publish the resulting images and/or audio in print and/or electronic media. I agree that Chatham University may use such images and/or audio of me with or without my name, at its staff’s discretion and for any lawful purpose, including such needs as publicity, illustration, marketing and Web content. *
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