2023 Roundtable Facilitator Intake - REGENERATE Conference

Roundtable Facilitator Information

Items marked with a + will be included on the conference website and virtual platform, and in the program.

Name +(Required)

First Last

Pronouns (optional)

Email(Required)

Email +

Please enter the email address that you would like to have listed in the conference program. Write none if you would like no email listed.

Phone(Required)

Primary Title and Affiliation +(Required)

The primary title and affiliation you enter here will be included on the conference website and virtual platform, and in the program. You have the option to submit a secondary title and affiliation below. If space allows, we may list the second title and affiliation, as well.

Secondary Title and Affiliation

Address(Required)

City State / Province / Region Country

Photos +(Required)

Drop files here or

Accepted file types: jpg, jpeg, tif, png, gif, Max. file size: 50 MB, Max. files: 4.

Please upload a headshot and/or photo(s) of yourself doing the work you love! You can upload up to four photos in the following formats: JPG, JPEG, TIF, PNG, and GIF. The maximum file size allowed for each photo is 50MB.

Personal Bio +(Required)

1500 characters maximum. Include your connection to the roundtable topic you're facilitating. Please note that we will copyedit and proofread your bio before posting it, but we will not alter its content.

Website +

Have you published books, papers, articles, or videos that you'd like us to include with your bio?

Yes

Please list the title(s) and/or URLs of your publications. +

Social Media Links +

Please list links or handles to social media accounts that you would like to be linked in Regenerate conference outreach.

Roundtable Title

Some of your roundtables already have titles. If you know your roundtable has a title please leave this blank. If it doesn't, or if you have a suggestion for a title, please complete this.

Roundtable description

Some of your roundtables already have descriptions. If you know the roundtable has a description that you approve of, you can leave this blank. If it doesn't have a description or you have suggestions, please fill this out.

Scheduling

The 2023 REGENERATE Conference will take place Nov 1-3 in Santa Fe, NM. The roundtables will take place in the afternoons of November 2 and 3 and we ask that all roundtable facilitators are at the venue by 2PM each of those days.

I am available in the afternoon on the following days:(Required)

Thurs Nov 2

Fri Nov 3

We will inform you of the final schedule as soon as it is set.

Do you have any scheduling conflicts on Nov 2 or 3 that we should be aware of?

Anything else you want us to know at this time?

Thank you!

We will be in touch soon to confirm the exact times of the roundtables and additional facilitator information.

Phone

This field is for validation purposes and should be left unchanged.