Larger Community Foundations 2012 Conference Registration Survey

1. Please Provide the Following Registration Information

This registration information will confirm your attendance at the 2012 Larger Community Foundations Conference on January 25-27, 2012 in Scottsdale, AZ. The last question asks for your general input/ideas for the conference. Thank you!

1. Please provide the following information (name as you would like it to appear on your name tag):

Please provide the following information (name as you would like it to appear on your name tag): Name (First, Last):
Foundation:
Street Address (no PO Boxes):
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

2. Foundation Website Address

Foundation Website Address

3. Your title:

Your title: CEO

President

President & CEO

Board Chair

Other (please note below)

Other (please specify)

4. If you will be bringing a guest, please enter guest's name (as you would like it to appear on the name tag)

If you will be bringing a guest, please enter guest's name (as you would like it to appear on the name tag) First Name:
Last Name:

5. Please provide/confirm your Assistant's name and contact information.

Please provide/confirm your Assistant's name and contact information. Name:
Email Address:
Phone Number:

6. Is the CEO of the Foundation retiring in 2011 or 2012?

Is the CEO of the Foundation retiring in 2011 or 2012? Yes

7. Do you require hotel accommodations at The Sanctuary (www.sanctuaryoncamelback.com)? Please double-check your schedule as we will consider your reservation confirmed and guaranteed by early December; this is high season for the resort and cancellation fees will likely apply. We have secured a discounted rate of $275/night plus tax.

Do you require hotel accommodations at The Sanctuary (www.sanctuaryoncamelback.com)? Please double-check your schedule as we will consider your reservation confirmed and guaranteed by early December; this is high season for the resort and cancellation fees will likely apply. We have secured a discounted rate of $275/night plus tax. I will need a room for the scheduled meeting dates only (checking in Tuesday January 24, checking out on Friday January 27)

I will not stay for the full conference (please indicate specific check-in/check-out dates below)

I would like to extend my stay for either before or after the meeting (the conference discount rate applies the 3 days before and after, based on availability) - please note specific dates below.

I will NOT need a hotel room

8. If you plan to EXTEND YOUR STAY before or after the conference dates, or will NOT STAY FOR THE FULL CONFERENCE, please indicate check-in and check-out dates. Please note that the extension will also be considered confirmed by early December. This is high season for the resort and cancellation fees will apply.

If you plan to EXTEND YOUR STAY before or after the conference dates, or will NOT STAY FOR THE FULL CONFERENCE, please indicate check-in and check-out dates. Please note that the extension will also be considered confirmed by early December. This is high season for the resort and cancellation fees will apply. Check-in date:
Check-out date:

9. Please tell us your preferences/special requests with regard to your hotel room:

Please tell us your preferences/special requests with regard to your hotel room: One bed

Two beds

Other special requests (i.e., handicapped accessible, additional rooms needed, etc.)

10. Any special needs required at the hotel? If so, please be specific (i.e., allergies, food restrictions, hearing impaired, wheelchair, etc.).

Any special needs required at the hotel? If so, please be specific (i.e., allergies, food restrictions, hearing impaired, wheelchair, etc.).

11. Will you be attending the reception and dinner at the resort on Wednesday January 25?

Will you be attending the reception and dinner at the resort on Wednesday January 25? Yes, I plan to attend the reception and the dinner

I plan to attend the reception but not the dinner.

I plan to attend the dinner but not the reception.

No, I am not attending the reception or the dinner.

Will your guest attend as well? An additional fee will apply.

12. We are very excited to be holding our Thursday evening dinner and program at the Musical Instrument Museum in Phoenix. Do you plan to join us for this evening?

We are very excited to be holding our Thursday evening dinner and program at the Musical Instrument Museum in Phoenix. Do you plan to join us for this evening? Yes

Will your guest attend as well? An additional fee will apply.

13. This year, you can choose the way you'd like to receive the conference notebook. Electronic copies will be in .pdf format and emailed via zip file; you can select which sections (if any) you'd like to print on your own. Hard copy notebooks will be shipped approximately 2 weeks prior to the conference dates.

This year, you can choose the way you'd like to receive the conference notebook. Electronic copies will be in .pdf format and emailed via zip file; you can select which sections (if any) you'd like to print on your own. Hard copy notebooks will be shipped approximately 2 weeks prior to the conference dates. Electronic copy sent to my email address on file.

Hard copy notebook shipped to my Foundation address.

Both.

14. Any additional comments or input to help us create a great conference in 2012?

Any additional comments or input to help us create a great conference in 2012?

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1. Please Provide the Following Registration Information

Larger Community Foundations 2012 Conference Registration
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