Exit

ENCOUNTER Charlotte Registration - April 24th and 25th, 2024

Spring ENCOUNTER (1.5 days): $550
Scholarships are available.

Question Title

* 1. Name

First Name

Last Name

Prefer to be called

Question Title

* 2. Year of birth (enter 4-digit birth year; for example, 1976)

Question Title

* 3. Gender

Question Title

* 4. Race/Ethnicity

Question Title

* 5. Headshot

Upload your photo here.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

Question Title

* 6. Current Employer

Question Title

* 7. Occupation/Title

Question Title

* 8. Home Contact Information

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Cell Phone Number *

Question Title

* 9. Preferred Contact Information (if different from above)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 10. Emergency Medical Contact Person

Name *

Relationship to you *

Mobile Phone Number

Question Title

* 11. To ensure accurate application of your payment, please note below any other name or entity that may be associated with your ENCOUNTER tuition. If none, please put N/A.

Question Title

* 12. I would be interested in learning about scholarship opportunities for ENCOUNTER.

Yes.

No.

Question Title

* 13. How did you hear about ENCOUNTER Charlotte?

Question Title

* 14. How long have you lived Charlotte?

Question Title

* 15. Where did you previously live (if anywhere)?

Question Title

* 16. Why did you relocate to Charlotte (if applicable)?

Question Title

* 17. What are the top three Charlotte leadership areas you would like to know about?

1st Leadership Area

2nd Leadership Area

3rd Leadership Area

Question Title

* 18. What are your current (or previous) volunteer interests?

1st Volunteer Interest

2nd Volunteer Interest

3rd Volunteer Interest

Question Title

* 19. Do you have any food allergies or dietary restrictions?

No.

Yes (please specify below)

Details of your allergy or restriction: