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2006 National Conference Registration Form

Instructions:

1. Please take a moment to complete the registration form below. Note that although only a few of the fields are absolutely required, you are strongly encouraged to complete all of the fields that are relevant to you.

2. Once you have completed the form, click on the Review button at the bottom of the page. If you missed a required field, an error message will appear below these instructions. If this happens, make the appropriate changes and re-click the Review button.

3. Once all required fields have been filled in and you have clicked on Review, a Submit button will appear at the bottom of the page. Re-check your responses if you'd like to, then click on the Submit button to submit your registration form and proceed to your payment options. Important: if you do not click on the Submit button, we will not receive your registration.

General Information:
Please note that your contact information will be shared with the other conference participants.
Name:
Salutation (Mr., Ms., Dr., Rev., etc.):
First Name:	??(required)
Middle Name or Initial (optional):
Last Name:	??(required)
Suffix (Jr., Ph.D., etc.):
Name Tag:
How would you like your name to appear on your name tag? Please include your last name.	??(required)
Contact information:
Organization or School:
Your Title/Position:
Address (line 1):
Address (line 2):
City:
State or Province:
Country (if not U.S.):
Zip Code or Country Code:
Daytime Phone:	??(required)
Alternative Phone:
Email Address:	??(required)
Website Address:
Biographical Information:
Please provide us with a brief one-paragraph bio which we will share with other conference participants. Please limit your bio to 100 words. We suggest that you write your bio in a separate program and cut & paste it into the field below.
If more than 100 words are provided, we will edit the text without your input.
Demographic Information:
Diversity among conference participants and presenters is very important to us. The following information will help us determine how we are doing on attaining our goals.
What is your gender?
What is your age?	under 18 ? 18 - 25 ? 26 - 35 ? 36 - 45 ? 46 - 55 ? 56 - 65 ? over 65
What is your race/ethnicity? (Latino, white, etc.)
Special Needs:
Do you have any special needs that we should be aware of in order to make sure you are comfortable and are able to fully participate?
Examples would be wheelchair assistance, vegetarian food, etc.
NCDD Conference in San Francisco from August 4th - 6th, 2006
Will you be participating in the conference?
Only select "no" if you choose not to participate in the main conference and only plan to attend a pre-conference activity. Please note that the registration fee covers some meals, but does not cover your lodging.
?Yes? ?No	Early Registration Fee: $300 until June 26th. The registration fee will increase to $450 on June 27th, 2006.
Pre-Conference Activities on August 3rd, 2006
Will you be participating in a pre-conference activity on August 3rd, 2006?
If you wish to attend a pre-conference activity, select one below. For more information about each, look over the pre-conference training descriptions (this will open in a new browser window).
Not Participating
Please leave this option selected if you will not be participating in an activity on August 3rd.
	I will not be attending a pre-conference activity.
Full-Day Trainings:
?Option One ??$125	Choosing Deliberative and Dialogue Techniques that Work Janette Hartz-Karp, 21st Century Dialogue
?Option Two??$125	The World Caf?: The Art of Hosting Conversations That Matter Ken Homer and Nancy Margulies, The World Caf?
?Option Three??$125	Tailoring Dialogue To Cultural Contexts -- A Collaborative Exploration Meenakshi Chakraverti, Public Conversations Project
?Option Four??$125	Compassionate Listening: Bringing Our Hearts to Dialogue and Deliberation Work Rachel Eryn Kalish, M.C. and Susan Partnow, The Compassionate Listening Project
Half-Day Trainings:
There will be two half-day pre-conference trainings offered this year. Attendees may participate in both (choose Option Seven).
?Option Five??$75 -- 9:00am to 12:30pm	Fast Forward Framing for Critical Issues Carole and Craig Paterson, National Issues Forums
?Option Six??$75 -- 1:30pm to 5:00pm	Taking Dialogue & Deliberation to Scale Ashley Boyd and Janet Fiero, Ph.D., AmericaSpeaks
?Option Seven??$125	Both half day trainings.
BrainJam!
NCDD is proud to co-host an all day BrainJam! on open source, internet and web 2.0 technology and how the dialogue & deliberation field can benefit from these readily available resources. This highly participatory conversation will be run by Chris Heuer, founder of BrainJam!
BrainJam!??$50	BrainJam!: A Conversation About Technology Chris Heuer, BrainJam!
Exhibit Space at Conference:
If you wish to host exhibit space at the conference, please select one of the two choices below. If your exhibit does not suit a tabletop display, contact the conference organizers concerning special exhibit arrangements. This year's display tables will be located where there is heavy foot traffic and high visibility.
Full six- to eight-foot display table.	??$400
Half six- to eight-foot display table.	??$200
Donations to the Conference Scholarship Fund:
Please consider making an additional contribution to the conference if you can. Your contribution to our scholarship program will help cover the expenses of those who may not otherwise be able to attend. Contributors to our scholarship fund will be listed in the conference program and on the website.
$200 Donation	??$200
$100 Donation	??$100
$50 Donation	??$50
Have you received a discount code?
If you have been selected as a workshop leader or offered a scholarship, you may have received a six digit discount code in your acceptance email (depending on the type of discount received). If you have received a discount code, please enter it in the field below, if you choose to use it. Discount codes are only made up of letters and numbers. Any other symbols will cause your code to be ignored.
Enter your discount code for conference registration here: ??
Enter your discount code for pre-conference trainings here: ??
Thank You:
We are thrilled that you have decided to attend the 2006 National Conference on Dialogue & Deliberation. We look forward to seeing you in August! Please review or submit your registration by clicking the box below.
Preview your responses before submission.
Review your submission: