AAPIP National Network Convening & Annual Meeting Registration Form * = Required

Name*: ________________________________________________________________ Preferred Gender Pronoun: _________________________________________________ Title*: _________________________________________________________________ Organization*: ___________________________________________________________ Giving Circle: ____________________________________________________________ Email Address*: __________________________________________________________ Phone Number*: _________________________________________________________ Twitter Handle: __________________________________________________________ Panel Preference We will feature three break-out sessions in the afternoon. Please select one of the following to attend.* o Session A: Innovative Partnerships in Community Philanthropy o Session B: Islamophobia: How to Mobilize Resources & Action in a Climate of Hate & Division o Session C: Working at New Intersections for Social Justice and Community Change Please note that these decisions are not final, and that you can change your mind about your panel attendance at the Convening. We will use your answers to gauge interest and numbers.

Accommodations Please let us know if you require any ADA accommodations. _________________________ Please let us know if you have any dietary restrictions/allergies. We will do our best to accommodate requests. ____________________________________________________ ______________________________________________________________________

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  Disclaimer I agree that my name and organization can be listed on an attendee list to be distributed at the Convening.* o Yes o No Are you a current AAPIP member?* Do you hold Associate and/or Individual Membership, and/or membership with your Institution?

o Yes o No Is this your first time attending an AAPIP convening? o Yes o No How did you hear about the event? ____________________________________________ Rates The registration fee includes lunch and the National Giving Circle Campaign Reception. There will be an additional fee and separate registration form to attend a Dine Around. • •

Members: $100 Non-Members: $150

If you have questions about your membership status, please email [email protected]. Please enclose a completed copy of this registration form and your check made payable to AAPIP, and send them to: AAPIP 2201 Broadway, Suite 720 Oakland, CA 94612 Mail must be postmarked by May 27, 2016. Cancellation Policy Partial refunds may be available, less a $10.00 administrative fee, if requested by writing to [email protected] by May 16, 2016 at 5:00 PM PDT. Individuals who cannot attend the 2016 AAPIP National Network Convening after registering are encouraged to find an alternate to attend their place. No refunds will be made after May 16, 2016 for any reason.

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AAPIP National Network Convening Registration Form Paper Copy.pdf

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