Thank you for agreeing to be a roundtable facilitator at the 2026 REGENERATE Conference! We are excited to have you join us. Completing the following form will provide us with the details to ensure you are represented in our conference materials accurately. If you have questions or need help with this form, please contact maria@quiviracoalition.org.

2026 Roundtable Facilitator Intake Form

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

General Information

Items marked with a + will be included on the conference website and virtual platform, and in the program.
Name +(Required)
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.
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.
Address(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.
    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.
    Please list links or handles to social media accounts that you would like to be linked in Regenerate conference outreach.
    If you would like to use the title you submitted in your proposal please leave this blank.
    If you would like to use the description you used in your roundtable proposal please leave this blank. Some of your roundtables already have descriptions.

    Scheduling

    The 2026 REGENERATE Conference will take place Oct 28-30 in Santa Fe, NM. The roundtables will take place in the afternoon on Thursday Oct 29 and Friday Oct 30th and we ask that all roundtable facilitators are at the venue at least 45 minutes prior to the roundtables each day to get settled.
    I am available at the following times(Required)
    We will inform you of the final schedule as soon as it is set.

    Thank you!

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