Washington Briefing 2017 Online Registration Form
Registration Policy: You must be a staff person, board member, or trustee of a grantmaking institution or affinity group to attend the Funders Network Washington Briefing. (Consultants are not eligible to attend.)
Registrant's First Name (*)
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Registrant's Last Name (*)
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Title
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Foundation
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Address 1 (*)
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Address 2
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City (*)
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State (*)
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Zip Code (*)
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Telephone (*)
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Mobile Phone
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Fax
Email Address (*)
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Please check one:
Registrant's Position



Attendee Names (if more than one)
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Affinity Group
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Emergency Contact Information
Name
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Relationship
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Contact's Phone
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Contact Phone alt.
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Please tell us what you need, including any mobility, audio, or visual access requirements, to fully participate in the conference. If filling out the form for more than one attendee, please indicate names requiring special needs.
Accessibility
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Please indicate if you have any dietary restrictions. If filling out the form for more than one attendee, please indicate names and restrictions.
Dietary Restrictions
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Working Groups/Pre-Meetings, Members Only - Wed., Mar 15
Women of Color WG retreat
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WOC WG Retreat Attendee Names
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Youth Leadership pre-meeting
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Youth Leadership Attendee Names
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International Funders WG Dinner
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Int'l Funders WG Attendee Names
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Total number of Registrations/Attendees (*)
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**** Discount Pricing: First registration at full price; $100 off additional registrations when more than one person from the same foundation registers at the same time. ****
Registration Cost (ea.) - Not refundable after March 8 (*)
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Payment Type (*)
Please choose one.
If "Online" is chosen, you will be redirected to the website of the Funders Network's chosen payment processor, Payjunction, for secure credit card processing. Please note that we only accept VISA, Mastercard, and American Express, either online or by mail/phone.
*If paying by check or CC by mail, please mail to: Funders Network, P.O. Box 750, Rockville, MD, 20848-0750
Enter the challenge word(s) at right. This helps prevent spam. If you can't read them or there is a letter that's not on your keyboard, click the refesh icon (red over/under arrows) to get different challenge words.
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A confirmation email of this registration will be sent to the email address that was entered.