Name:	__________________________________________________
Title:	__________________________________________________
Company:	__________________________________________________
Address:	__________________________________________________
	__________________________________________________
Telephone:	__________________________________________________
Fax:	__________________________________________________
Email:	__________________________________________________

I'm interested in:
check all that apply; for * items, please attach 1-2-page resume or brief biography in relevant detail.

Sponsoring the 2007 Workshop

designing the workshop; includes being member of planning group*
presenting at the workshop (please list topic below)*
being a small group facilitator*
attending the workshop (in November 2007)
being kept informed of progress
participating in some other way -- please specify below

Please send information to my colleagues (give their contact information)

Please update my contact information (specify below)

Sorry! I can't participate at this time. Please contact me again later

Remarks/requests – if necessary, please attach additional sheets

_______________________________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

Version 1.2; revised September 21, 2007