REGISTRATION
ONE registration form per person
Fields marked with an * are required to complete this registration

* Name:   Title:

Organization:

Address:

City:   State:   Zip:

Phone:   Cell Phone:

* E-Mail:

* 5:45pm Dinner clusters (Choose ONE)
Models of advisory business
Field building
Advisors and financial firms
Intergenerational leadership
Coaching leaders and families
Client problem-solving

PAYMENT OPTIONS

* Select ONE
I am sending a check by mail (it must arrive by June 17th)

Expect a check from our firm/organization for people.
    The check will be for (add names):

I/we wish to pay by credit card.
    The amount will be $175 x = $ as the program fee.
    Please call me at the following number so that
    Inspired Legacies can get my credit card payment by June 17th.

Note: if payments are not received by June 17th, we cannot assure a place due to limitations of space.

* I understand that I/we are responsible for breakfast, dinner and hotel/and travel costs and reservations. See the flyer for the info on the hotel and location. They are across the block from each other, in downtown Phili, only 20 minutes from the airport AND a few blocks from train and subways.

DONATIONS

I/we'd like to make a contribution to Inspired Legacies to support this program and your important field building work.
$25   $50   $75   $100   $250   $500
$750   $1000   $$2500   Other amount

Please list gift from
I/we would prefer to be anonymous.

CONTACT ME

Call me, I'd like to donate stock, or discuss a legacy or credit card donation.
Call me/us. We'd like to discuss sponsorship opportunities for Inspired Legacies and Bolder Giving at the
$500   $1000   $2500   $5000 level and know the offerings available on your sites and for this and other programs for advisors, funders, and nonprofit leaders.

PERSONAL GOALS

* Your three personal goals or comments or preferences: (Note, the building is wheelchair accessible)
1.
2.
3.

Comments: