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ENCORPS 2016 SUMMIT REGISTRATION FORM
Maple Hill Farm Conference Center, Hallowell, Maine
May 23, 2016

Sending in your registration form as soon as possible will help us prepare and ensure your needs are met while at the Summit. Please complete the registration form individually even if you are attending with a significant other. After we receive your completed registration form, we will be in contact with more details as the Summit draws closer. We are looking forward to seeing you at the Summit on May 23, and we hope you are looking forward to the Summit as well. Thank you and see you soon!

There is a $15 non-refundable registration fee to attend this year's Summit. This fee will help us to defray a small portion of the costs for the Summit and includes meals and refreshments. Deadline for all registrations is: May 2, 2016. Slots will be filled on a first come, first served basis.

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* 1. Complete Mailing Address:

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* 2. Are you currently an ENCorps member?

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* 3. This year we are providing handouts in paper and in electronic format online. Please indicate which option you would like.

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* 4. Would you like to participate in a carpool to and from the summit?

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* 5. Will you need any special dietary accommodations while at the Summit? Please specify.

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* 6. Activities at the Summit will include walking and climbing stairs at various times throughout the conference. Are there any other disability accommodations you would like us to know about? Please specify (i.e. need for wheelchair accessibility, limited ability to climb stairs, etc.)

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* 7. There will be three skills-building workshops for each breakout session on May 23rd. Rank your preferences 1, 2, and 3 for the morning session (11:00 AM - 12:15PM).

  1st Choice 2nd Choice 3rd Choice
Conflict Transformation in Our Work and Community Volunteerism - Leigh Tillman
Using Technology to Create, Connect, and Contribute - BoomerTECH Adventures
Grantswriting 101: Tips and Tools for a Successful Proposal - Lelia DeAndrade

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* 8. Rank your preferences 1, 2, and 3 for the afternoon breakout session (1:30 PM to 2:45 PM).

  1st Choice 2nd Choice 3rd Choice
The Strength of Difference in Team Engagement - Leigh Tillman
Tell the World About Your Project! - Meg Haskell
Grantswriting 101: Tips and Tools for a Successful Proposal - Lelia DeAndrade

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* 9. Finally, please write any additional comments, questions, or concerns in the space below.

Registration fee: There is a $15 registration fee to attend the Summit this year. Your registration will not be considered complete until we receive payment.

To pay by check, please make your check payable to: University of Maine. Write “ENCorps Summit” in the memo line of the check. Please mail your registration check to:

Encore Leadership Corps
Summit 2016 Registration
UMaine Center on Aging
25 Texas Ave
Camden Hall
Bangor, ME 04401

To pay by credit card, please visit the ENCorps website address below for more information. You will also have the option to process payment at the end of this survey:

www.encoreleaders.org/news-and-events/summit/

*Deadline for all registrations is: May 2, 2016

Questions? Please call Kate Kinney at 207-262-7919 or e-mail kathryn.kinney@umit.maine.edu
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