Inscripción para Ntosake 2021 Correo Electrónico* Nombre* Nombre Apellido Número Telefónico*Organización Afiliada*ABLE NH (Advocates Building Lasting Equality)ABLE (Atlantans Building Leadership for Empowerment)ACTION (Alliance for Congregational Transformation Influencing Our Neighborhoods)Action of Greater LansingAsamblea de Derechos CivilesBRIDGE MDCALEBCUSH (Congregations United to Serve Humanity)ESTHER (Equality, Solidarity, Truth, Hope, Empowerment, Reform)EXPOFCCG (Faith Coalition for the Common Good)Gamaliel CaliforniaGamaliel IllinoisGamaliel MichiganGamaliel NationalGenesisGMC (Gamaliel of Metro Chicago)ISAAC (Interfaith Strategy for Advocacy & Action in the Community)JOB (Justice Overcoming Boundaries)JONAH (Joining Our Neighbors, Advancing Hope) WIJOSHUA (Justice Organization Sharing Hope and United for Action)MCU (Metropolitan Congregations United)MICAH (Milwaukee Inner-city Congregations Allied for Hope)MICAH (Memphis)MORE2 (Metro Organization for Racial and Economic Equity)MOSES (Madison, WI)MOSES (Metropolitan Organizing Strategy for Enabling Strength)NAOMINOAH (Nashville Organized for Action and Hope)PIIN (Pennsylvania Interfaith Impact Network)PNCC (Pilsen Neighbors Community Council)QCI (Quad Cities Interfaith)RIC (Racine Interfaith Coalition)SOPHIA (Stewards Of Prophetic, Hopeful, Intentional, Action)SSAC (South Suburban Action Conference)The Ezekiel ProjectUCM (United Congregations Metro East)We-ROC (Washtenaw Regional Organizing Coalition)WISDOMThis field is hidden when viewing the formStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificReligión o DenominaciónInstrucciones o restricciones dietéticasInstrucciones de accesibilidadCompañero de habitación preferidoContacto de emergencia*Se requiere una prueba de vacunación antes del inicio del entrenamiento o de una prueba de covid negativa reciente.* Estoy de acuerdo en proporcionar una prueba de vacunación o prueba de covid negativa. Las habitaciones de ocupación doble cuestan $395, las habitaciones de ocupación individual cuestan $495. Referencia de Pago* Pagando en linea ahora, $395 Pagando por telefono o con cheque, $395 Opción Habitación individual+100 Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name Make check payable to Gamaliel Mail to: 5401 S Cornell St. Suite 301, Chicago IL. 60615 For payments over the phone please call 312-357-2639
