2011 Food and Thought - an interfaith and intercultural conversation

February 19, 2010 - 23:00 — Anonymous

Registration form for 2011 Food and Thought.

Please fill in each field and click Register Now button to submit. You will receive a confirmation on your screen after the form has been submitted. Thank you for registering.

Your Name: *

Please provide your first, last name, and any other titles you wish. (e.g., The Rev. Dr. John Smith)

Your Address: *

Please enter your full street address. (e.g., 123 Oak Street, APT 12)

Your City: *

Please enter your city (e.g. Kansas City).

Your State:

Please enter your state abbreviation (e.g. KS).

Your Zip Code: *

Please enter your zip code (e.g. 67213).

Your Faith Tradition: *

Please enter your Faith Tradition. If you do not have a Faith Tradition, please type "None."

Your Phone Number: *

Please enter your phone number so that we are able to contact you with any changes to your registration. We do not share phone numbers. (e.g. 816-555-1234).

Your Email:

Please enter your email address. (e.g., user@domain.com)

Your Race/Ethnicity:

Please enter your Race/Ethnicity so that we can have a diverse group at each home.

Your Special Considerations:

Please enter any special considerations you have (e.g. vegetarian diet).

Your Role: *

Please select your role for this event.

If Host- number of guests you can accommodate:

If you signed up to be a Host, please choose the number of guests you can comfortably accommodate in your home.

Guest Name:

If you wish to bring a guest with you, please fill in the Guest contact information.

Guest Address:

Please enter your guest's street address.

Guest City:

Please enter your guest's city in which they reside.

Guest State:

Please enter the state in which your guest resides.

Guest Zip Code:

Please list the zip code in which your guest resides.

Guest Phone Number:

Please enter your guest's phone number (e.g. 816-555-1234).

Guest Email:

Please enter your guest's email address (e.g. john@hotmail.com).

Guest Faith Tradition:

Please enter your guest's Faith tradition. If your guest does not have a Faith tradition, please enter "None."

Guest Race/Ethnicity:

Please enter your guest's race/ethnicity so that we are able to have diverse groups in the homes.

Guest Special Considerations:

Please enter any special considerations for your guest (e.g. Kosher diet).