Conference Registration Form

Conference Attendee Information

Name *

First

Last

Position Title *

Email *

Affiliated Organization (if any) *

Mobile Phone *

Home Address *

Address Line 1

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City

State

Zip Code

Do you hold a leadership position in an organization or department of an organization?

Do you consider yourself an advocate/activist who supports the following causes:

Social Justice
Climate Change and Environmental Justice
Arts & Culture
Other

Are you involved in any advocacy and/or activism projects in your local community?

Is there a particular advocacy/activism project that you would like to have us highlight at the conference?

How did you hear about the Conference? *

Payment Information

Conference Registration Fee *

Price: $165.00

Name on Card *

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Last

Credit Card Information *

Card Number

Expiration

/

Security Code

Billing Address *

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Address Line 2

City

State

Zip Code

Questions? Contact Isobel Chang, Marketing Director at ichang@ballettheatre.org or call 617-945-1944.