The Politics of the Brokenhearted: October 2010

"The Politics of the Brokenhearted"
A Center for Courage & Renewal conference with Parker J. Palmer on habits of the heart and the future of American Democracy.

October 21-24, 2010
Warren Conference Center
Ashland, MA

Deadline for early bird registration: August 1, 2010

1. Name:

Name: First
Middle
Last

2. Contact Preference - Home.

Please complete the sections below if you prefer that we contact you at home.

If you prefer that we contact you at work, you may skip this question and respond to the following question (Contact Preference - Work).

Contact Preference - Home. Please complete the sections below if you prefer that we contact you at home. If you prefer that we contact you at work, you may skip this question and respond to the following question (Contact Preference - Work). Home Address Line 1
Line 2
City
State
Zip
Country
Home Phone
Cell Phone
Fax
Home Email

3. Contact Preference - Work

Contact Preference - Work Work Address Line 1
Line 2
City
State
Zip
Country
Work Phone
Cell Phone
Fax
Work Email

4. Emergency Contact

Emergency Contact Name:
Phone Number:

5. Special Dietary Needs (if any):

Special Dietary Needs (if any):

6. Our programs are underwritten, in part, by individual and foundation sponsors and we aim to engage a broad and diverse range of participants who will contribute to and benefit from this dialogue. We invite you to address these questions:

• What draws you to participate in this conference?
• How would you describe your work or vocation?
• What is a question you are holding about our civic life and democracy?
• What helps sustain you in your efforts for justice/integrity/wholeness? What gives you hope to carry on?

Note: Responses will be compiled and shared with all conference participants.

Our programs are underwritten, in part, by individual and foundation sponsors and we aim to engage a broad and diverse range of participants who will contribute to and benefit from this dialogue. We invite you to address these questions:

• What draws you to participate in this conference?
• How would you describe your work or vocation?
• What is a question you are holding about our civic life and democracy?
• What helps sustain you in your efforts for justice/integrity/wholeness? What gives you hope to carry on?

Note: Responses will be compiled and shared with all conference participants.

Cost of Program: The program fee includes all meals and overnight accommodations. Numerous individuals have been invited who will need financial assistance to attend. We ask those who can, to also contribute to the scholarship fund.

PROGRAM FEES:

$1950 Program fee-based on single occupancy

$1550 Program fee-based on double occupancy

$1150 Program fee-based on multiple beds in a cabin

$1000 Program fee-commuter rate, includes all meals

You make may your payment on-line via PayPal by returning to the Center's website. Or you may send a check into the Center for Courage & Renewal at: Center for Courage & Renewal 321 High School Road NE, Suite D3, #375 Bainbridge Island, WA 98110

7. If you are in need of financial assistance in order to attend, please check here and we will follow up with a request for more information on your circumstances.

If you are in need of financial assistance in order to attend, please check here and we will follow up with a request for more information on your circumstances. I am requesting financial assistance.

8. If you have a roommate request, please enter the name of your requested roommate(s):

If you have a roommate request, please enter the name of your requested roommate(s):