Save & Return

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General Information

First Name *

Last Name *

Staff Conference Role *

Birthday Month *

Birthday Day *

Age Group

Gender *

Cell phone number *

Work phone number *

Work email address *

Email address *

Emergency Contact *

	Name	Phone Number	Relationship
Contact:	Name	Phone Number	Relationship

Do you have any allergies to food or medications, or any dietary restrictions (Kosher, Halal, vegetarian, vegan, gluten-free, etc.)? *

Please list your allergies/dietary restrictions here. *

Do you have any physical limitations that will prevent you from taking long walks, walking up/down stairs, etc.? *

Please describe * 🛈

Which “I Have A Dream” Foundation program are you a part of? *

What day did you begin working with the "I Have a Dream" Foundation? * +

Job Title *

When is your check in date? *

August 5

August 6

When is your check in date? *

How many nights will you be staying at the hotel? *

1

2

3

Registration Choice *

Single room

Double room (Please specify your room mate preference) Double room (Please specify your room mate preference)