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Exploring Identity - Leadership Institute Module
Each Tuesday from February 22 through March 29
7:00 - 9:00 p
m
Contact Details
Salutation
Please select...
Archbishop
Bishop
Chaplain
Dr.
Elder
Fr.
Imam
Lt. Colonel
Major
Mr.
Mrs.
Ms.
Msgr.
President
Pastor
Prof.
Rabbi
Rev.
Rev. Dr.
Sheik
Sr.
The Most Reverend
The Rev. Canon
The Rt. Rev.
The Very Reverend
Venerable
First Name
Last Name
Suffix
Please select...
CPA
D.D.S.
Esq.
II
III
IV
Jr.
M.D.
Ph.D.
Ret.
Sr.
Email
Phone Type
Home
Work
Cell
Home Phone
Work Phone
Cell Phone
Preferred Contact Method
Phone
Email
Address Type
Home
Work
Mailing Address
City
State/Province
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
Country
Please select...
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos ( Keeling ) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Côte d ' Ivoire
Croatia ( Hrvatska )
Cuba
Cyprus
Czech Republic
Congo ( DRC )
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands ( Islas Malvinas )
Faroe Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé and Prìncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Viet Nam
Virgin Islands ( British )
Virgin Islands
Wallis and Futuna
Yemen
Zambia
Zimbabwe
Organization / Congregation / School
Title
Faith Tradition:
Please select...
Atheist
Agnostic
Baha'i
Buddhist
Christian
Hindu
Jewish
Mormon
Muslim
Quaker
Secular
Sikh
Unitarian Universalist
None
Other
Other Faith Tradition (please specify):
Denomination:
Please select...
Catholic - Roman
Catholic - Ukrainian
Christian - Evangelical
Coptic Orthodox
Greek Orthodox
Jewish - Conservative
Jewish - Orthodox
Jewish - Reconstructing
Jewish - Reform
Jewish - Renewal
Latter-Day Saints
Mennonite
Muslim - Shia
Muslim - Sufi
Muslim - Sunni
Nation of Islam
Protestant - African Methodist Episcopal
Protestant - Baptist
Protestant - Episcopal
Protestant - Lutheran
Protestant - Presbyterian
Protestant - United Church of Christ
Protestant - United Methodist
Salvation Army
Other
Other Denomination (please specify):
Race/Ethnicity:
Please select...
African American
American Indian
Arab American
Asian
Black
Hispanic
White
Two or More Races
Other
Other Race/Ethnicity (please specify):
How did you hear about this training?
Please select...
Internet Search
Facebook/Social Media
Interfaith Philadelphia Email/Newsletter
Partner Email/Newsletter (ex: On Being, NCC, WHYY, etc.)
Referred by Friend/Colleague
Flyer/Poster
Attended Event/Met Interfaith Philadelphia Staff
Other (please specify in space below)
Other (please specify):
What is one skill you are especially interested in learning during this program?
How do you hope to use this material… in a work setting? Volunteer or community setting? Inter-personally?
Any additional comments for the organizers?
Program Fees
Interfaith Philadelphia Staff Members
Please check this box when registering.
Interfaith Philadelphia offers a sliding scale fee structure for our programs in order to welcome all from our community who wish to attend.
Please
click here
for guidance that will help you determine the right fee for you, between $25-$925, with $175 as the
adjusted standard cost
.
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