PFE Final Registrations 2023 HiddenPFE Final Registration code HiddenShow FormPFE welcomes up to three (3) persons to register per organization. We encourage organizations to register persons from multiple county locations and staff roles.(Required) By checking this box, I understand the registration limit and will coordinate with my colleagues to register up to three (3) individuals from our agency. Name(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Organization Name(Required) City(Required) City Preferred pronouns elles/they/them ella/she/her él/he/him Which sector(s) do you represent?(Required) Arts, culture, and humanities Animals Education Environment Foundation / funder Government Health / healthcare Human services Professional / association Business / consultant What is your organization’s annual budget?(Required)Annual BudgetUnder $100k$100 - $250k$250 - $500$500k - $1 millionOver $1 millionPFE is offering live Spanish interpretation with our partners, Uniendo Voces/ Bridging Voices. Would you like or prefer to engage Spanish-English interpretation services at this PFE event?(Required) Yes No, thank you With which of the following roles/ titles do you identify in your organization?(Required) Board member Executive: Director, CEO or Associate Director Director / manager Coordinator Staff Volunteer Business / consultant How many times have you attended PFE?(Required) First time 1-4 times 5-10 times More than 10 times How will you get to/from PFE at Santa Barbara Museum of Natural History? Please select your transportation option(Required) Opt in! I’m opting in for a complimentary, roundtrip bus/shuttle from Santa Maria or Buellton location. I’m excited to spend quality time connecting with my colleagues, skip driving on my own, and anchor my PFE wellness experience beginning to end Opt out! I’m opting out of the complimentary ride Please select pickup location(Required) Buellton Santa Maria Would you like a reusable PFE travel mug?(Required) Yes! I’d like a complimentary PFE travel mug No thanks, I’ll bring my own Would you like to volunteer as a PFE facilitator for a small group Community Conversation? Support for your role will include guiding discussion questions and a virtual Facilitators’ Orientation on Thursday, May 11 at 10:00 - 11:00 AM(Required) Yes, count me in! I’m interested, please reach out to me with more information. No, thank you I have someone to recommend for this role, please contact me. Why are you interested in attending Partnership for Excellence 2023? (Check all that apply)(Required) Connect / reconnect with colleagues Engage in organizational/professional development Learn strategies to advance wellness and equity Engage in community-based conversations Other (Other) reason for attending PFE 2023(Required) Will you be joined by colleagues from your organization at PFE?(Required) Yes No Maybe What aspect(s) of wellness are you most interested in exploring with PFE colleagues?What comes to mind when you imagine the relationship between wellness and advancing equity in Santa Barbara County?When you think of wellness within your organization, what metrics do you believe are important to track?Please list 1 non-work-related interest or passion you’re willing to share with others.(Required)PFE wants to understand who we are serving as part of offering and designing programs, and advancing equity. Knowing more about who you are will help us do this work. Please consider the following questions to better serve our guests. Your replies to these questions are optional, you can select "Choose not to answer".Your age(Required)Select Age25 or younger26-3940-5556-6970-8586 or olderChoose not to answerPrimary language(s) spoken at home(Required) English Spanish Chinese Tagalog Other, please specify Choose not to answer Other Language:(Required) Which of the following best describes your racial identity?(Required) Asian / Pacific Islander Black or African American Hispanic or Latino/Latinx Indigenous White Other, please specify Choose not to answer Other Identity:(Required) Which of the following best describes your sexual orientation?(Required) Gay Lesbian Bisexual Pansexual Heterosexual Other, please specify Choose not to answer Other Orientation:(Required) Which of the following best describes your gender identity?(Required) Cisgender male Cisgender female Nonbinary Transgender male Transgender female Other, please specify Choose not to answer Other Identity:(Required) Do you have any physical access requirements you would like PFE to be made aware of? (e.g. use of assistive equipment, visual aids, etc.)Are there additional identities you would like to recognize? (e.g.disability, religion, etc.?)Have a coupon code? Type in here: Please enter the name of the person you are replacing at PFE(Required) First Last Checks Payable to: The Foundation Roundtable/PFE 2023 P.O. Box 60157 Santa Barbara, CA 93160I understand that in attending PFE 2023, I give PFE/NPRN the rights and permissions to my photo/likeness, video, audio and/or name for use in future Partnership for Excellence communications and promotions without compensation or liability of any nature. This may include photo galleries, newsletters, press releases, public service announcements or other forms of electronic and print publication.(Required) Yes, I understand HiddenCheckout DetailsPFE 2023 Ticket Price: Total Credit CardCard Details Cardholder Name Δ
