<Organize To Win>

Organizing To Win

Participant Registration Form
Name:

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*
Highest Level of School Completed
Work Information

Tell Us About Your Work
Organization
Title
Organization's Purpose
Organization's Principal Activities
Your Responsibility and Principle Activity
Who Do You Report To
Work Website
General Information

Tell Us About Yourself
Describe Your Community Organizing Experience
Who Are The People You are Organizing, How Many? Where Do They Live?
What Are Your Greatest Challenges?
What is the Specific Problem They Need To Solve? How Do Your People Experience This Problem On A Day-to-Day Basis?
What Specific Change Would Be Required To Solve The Problem?
How Could You Imagine People Coming Together To Create The Power They Need To Achieve Change?
Please Share a Brief Personal Story About Why You Are Called To Accept Leadership
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References

Provide 3 References: Full Name, Email Address and Phone Number
Reference #1
Reference #2
Reference #2
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Organizing To Win