At the Church Center for the UN, NYC

New England Conference UMW Registration Form

Economic Justice: Ministry With the Poor

Educational Seminar

at the Church Center for the UN, NYC

April 25-27, 2017

United Methodist Women and community activists

rally for economic justice in Baxter Square Park

in Louisville, KY.

Please fill out the entire form and attach a non-refundable Registration Deposit of $25to secure one of the 40 slots (check made payable to NECUMW). The balance of $75 will be due no later than March 1st, 2017. Please send to the Registrar, Karen Pehrson, 56 Charles Wesley Court, Wells, ME 04090. Phone: 401-743-0573. Email: . Further hotel information will be sent upon receipt of registration deposit. Remember to contact your UMW for scholarship aid.

Name:______

FirstLast

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Address

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CityStateZIP

______UMW Unit _____yes; _____no

ChurchDistrict

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EmailHome and Cell Phone Numbers

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Emergency Contact PersonRelationship

______

AddressPhone Number

______Roommate(s):______

My preference is to book a room for 2 or 4 persons. (please circle) ______

When the Registration form is received, with the $25 deposit, detailed information about booking hotel rooms will be sent to you.

 Please fill out questions on reverse side.

Survey Questions:

I would like to share (strategies or concerns) what is happening in ______

______

(example: Our city ______is the first in the state to use Fair Trade products at civic events.)

I would like information about how the UN is addressing economic justice issues globally:

______Yes ______No ______OK, but not high priority

I would like to see the following topic / concern added to the program: ______

I would like to discuss specific strategies which our UMW can utilize:

______Yes ______No ______OK, but not high priority

Age Group: ____ under 30, ____ 30-44, ____ 45-64, ____ 65+

My background in economic justice includes (check all that apply):

____ formal education / ____ news / broadcast media
____ seminars, programs / ____ UMW events
____ UMW reading programs / ____ personal reading
____ job-related involvement / ____ campaigns
____ other / ____ UM news and print media

Have you travelled outside the U.S.? ____ Yes ____ No Where? ______

What major corporations / industries, employers are in your area:

______

We will have a pre-reading assignment before we attend the seminar. Do you have any recommendations for this assignment?

______

Would you like to have a daily short worship / reflection time outside of the seminar?

____ Yes ____ No ____ I would like to participate in the leadership.

How do you expect that this seminar might benefit your commitment to economic justice?

______

Thank you. This information will be shared with the seminar leaders to assist them to meet our needs.