Digital Disciple Network Summit 2019 Please complete the following for your Digital Disciple Summit registration and to receive information for FETC registration, Hotel information, and Summit details. Thank you! OK Question Title * 1. What is your first name? OK Question Title * 2. What is your last name? OK Question Title * 3. What is your phone number? OK Question Title * 4. What is your mailing address? OK Question Title * 5. What is the best email to reach you? OK Question Title * 6. Name of your diocese: OK Question Title * 7. Name of your Parish or Organization. OK Question Title * 8. Your ministry title: OK Question Title * 9. Please describe your current ministry? OK Question Title * 10. Areas of the Summit that interest me (High Interest = 5 and Low Interest = 1). Please indicate your interest for all categories. 1 2 3 4 5 Digital Discipleship Book 1 2 3 4 5 Summer Digital Disciple Camp for 6-9 Grade Students 1 2 3 4 5 Online Digital Disciple School 1 2 3 4 5 Summer Catechist Intensive 1 2 3 4 5 EdCamp Experiences for Catholic School Religion Teachers and Parish Catechists and Ministers. OK Question Title * 11. In order to attend the Summit, I . . . ...need a full sponsorship ...need a partial sponsorship ...do not need a sponsorship OK Question Title * 12. Regarding DD Summit Sponsorships, I suggest that you contact: Name Company Address City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number OK Question Title * 13. One sentence description about your named sponsor. OK Question Title * 14. I agree that you can use my name when you contact this sponsor. Yes No OK Question Title * 15. I prefer to contact this sponsor myself. Please send me any information I may need to share with this contact. Yes No OK Question Title * 16. I understand that I am responsible for registering for FETC, arranging for my hotel where the DDN Summit group will gather, and providing my transportation to Orlando. At the end of the Conference, depending on our Sponsor Drive, reimbursements will require the designated receipts with the required Summit Reimbursement form. I understand that I may only be partially reimbursed. Yes No OK Question Title * 17. Do you have any other comments, questions, or concerns? OK SUBMIT RESPONSE