October 19th – 21st 2007   
Together In Faith Collaborative - Facilitator Form
NAME:
ADDRESS:
CITY:
STATE:
ZIPCODE:
WORK PHONE:
CELL PHONE:
E-MAIL:
AFFILIATION:
TITLE:
FAITH DENOMINATION / SPIRITUAL BACKGROUND IF ANY:
ARE YOU CURRENTLY PART OF FAN (FAITH ACTION NETWORK):
YES
NO
PROGRAM INFO:
Please include a brief biography (100 words or less) for
inclusion in program. Please include educational background.
TITLE OF WORKSHOP:
WORKSHOP/SESSION DESCRIPTION:
Please include a brief description of workshop or session
(100 words or less) for inclusion in program.
EQUIPMENT NEEDED:
(Please indicate if you will need any Audio Visual Equipment;
Laptop etc. for  workshop)
DO WE HAVE YOUR PERMISSION TO INCLUDE YOUR CONTACT
INFORMATION IN THE PROGRAM?:
NO
YES
SERVICES REQUESTED: Check all applicable
ASL:
WHEELCHAIR ACCESSIBLE:
BRAILLE:
DIETARY (as noted)
OTHER (as noted)
HOUSING: Check All That Apply
FRIDAY NIGHT
SATURDAY NIGHT
SUNDAY
(I will be participating in
Collaborative, Team
Building & Lunch 9am-1pm)
Questions? Contact: hgrace@afsc.org or (734)222-9470
You will receive a
confirmation e-mail
within 72 hours of your
registration.

Please note:
To participate in ALL
team building activities a
General Release Form
needs to be submitted.
Information will only be
shared with necessary
personnel.

Please click here for form.

The General Release can
be faxed, mailed, e-mailed
or provided at time of
Collaborative.