The Conversation 2009

Registration form

Please note: there will be a cancellation fee applied if the registrant can not attend.

The Conversation is by invitation only.

Name*
Home address*


Work address*


Preferred mailing address	home work
Home phone*
Work phone*
Cell phone*
Preferred phone number	home work cell
Preferred email address*
Denomination
Emergency numbers*
Professional title*
Brief bio (5-7 sentences, to be circulated among the participants of The Conversation)*
Submit a photo	Please email it to theconversation1@hotmail.com
During The Conversation, I am most interested in discussing (please list up to five topics)*
What is the primary reason you chose to take part in The Conversation?
Any special accommodations needed?
Special dietary restrictions?

*denotes a required field


CLI (The Center for Leadership Initiatives) The Joseph and Harvey Meyerhoff Family Charitable Funds The Judy and Michael Steinhardt Foundation Targum Shlishi/Raquel and Aryeh Rubin The Covenant Foundation