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

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

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* 1. Name

First Name

Last Name

Prefer to be called

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

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* 3. Gender

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* 4. Race/Ethnicity

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* 5. Headshot

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* 6. Current Employer

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* 7. Occupation/Title

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* 8. Home Contact Information

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Cell Phone Number *

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

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 10. Emergency Medical Contact Person

Name *

Relationship to you *

Mobile Phone Number

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* 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.

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

Yes.

No.

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* 13. How did you hear about ENCOUNTER Charlotte?

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* 14. How long have you lived Charlotte?

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

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

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

1st Leadership Area

2nd Leadership Area

3rd Leadership Area

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

1st Volunteer Interest

2nd Volunteer Interest

3rd Volunteer Interest

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

No.

Yes (please specify below)

Details of your allergy or restriction: