Catholic Charities USA

Individual Registration Form

2014 ANNUAL GATHERING | OCTOBER 4 - 7| Charlotte, NC
Attendee
Organization:
Job Title:
Address:
City/State/Zip: Phone:
Email: Twitter
Emergency Contact
(name/phone)
Special
needs/restrictions
In the quantity field below, enter the total number of registrations. The form will calculate the total.
Quantity Registration Type Unit Price Total
0 Individual (Early Bird) June 1 - August 22 $450.00
0
Individual (full) After August 22nd
$525.00
0
Individual (full) NON MEMBER AGENCY
$750.00
0 Individual (First-Timer) $400.00
0
Individual (Young Professional) under 40 years of age
$400.00
0 Individual (Spouse) of a member agency employee $325.00
0
Individual (Spouse) NON MEMBER AGENCY
$400.00
0
Individual (1 day Sunday) October 5
$275.00
0
Individual (1 day Sunday) NON MEMBER AGENCY October 5
$400.00
0
Individual (1 day Monday) October 6
$275.00
0
Individual (1 day Monday) NON MEMBER AGENCY October 6
$400.00
0
Individual (1 day Tuesday) October 7
$275.00
0
Individual (1 day Tuesday) October 7
$400.00
0
GALA (Ticket) October 6
$50.00
0
INSTITUTE (full) Saturday, October 4
$100.00
0
INSTITUTE (full) NON MEMBER AGENCY Saturday, October 4
$150.00
Total:
Are you attending an Institute? please select one
Name on Card: Exp. Date:
Card Number: Security:
Signature:
Send completed forms to:
Catholic Charities USA
2050 Ballenger Avenue, Suite 400 | Alexandria, VA 22314
Payment Method
Check this box if you DO NOT want to be included in our Attendee Lists.
Use the dropdown to find your Affiliate Member organization. If
you are not affiliated with an Affiliate Member, select Not Applicable.
How are you related to the Agency?
Use the dropdown to find your main Diocesan agency (state, city). If
you are not affiliated with a Catholic Charities agency, select Not Applicable.
Attendee (one per registrant)
VISA Mastercard
My check is enclosed American Express Discover
Phone: (703) 549-1656 | Secure Fax: (703) 549-1728
Not Applicable
10163582 - AK - Anchorage
10163583 - AK - Juneau
10163584 - AL - Birmingham
00038390 - AL - Mobile
10163585 - AR - Little Rock
10163586 - AS - Pago Pago
00005299 - AZ - Phoenix (Catholic Charities)
10133020 - AZ - Phoenix (Found. for Sr. Living)
00059166 - AZ - Tucson (Southern AZ)
00040646 - CA - Fresno
00065313 - CA - Los Angeles
00034227 - CA - Oakland (East Bay)
00023508 - CA - Sacramento
00065203 - CA - San Bernadino
00005389 - CA - San Diego
00043127 - CA - San Francisco
00005627 - CA - San Jose (Santa Clara)
00038391 - CA - Santa Ana (Orange County)
00034066 - CA - Santa Rosa
10369477 - CA - Seaside (Monterey)
10150241 - CA - Stockton
10163594 - CO - Colorado Springs
10139899 - CO - Denver
10161787 - CO - Pueblo
00022379 - CT - Bridgeport (Fairfield)
00085445 - CT - Hartford
10163595 - CT - Norwich
00005418 - DC - Washington
10148272 - DE - Wilmington
00075253 - FL - Jacksonville (St. Augustine)
00005427 - FL - Miami Shores
10162845 - FL - Orlando (Central FL)
10093927 - FL - Palm Beach
00038395 - FL - Pensacola (NW Florida)
00038394 - FL - St. Petersburg
00074495 - FL - Venice
00038421 - GA - Atlanta
10163968 - GA - Savannah
10144625 - GU - Barrigada (Hagatna)
00038396 - HI - Honolulu
10369904 - IA - Davenport (Social Action)
00034765 - IA - Des Moines
00075264 - IA - Dubuque
00035410 - IA - Sioux City
10163969 - ID - Boise
10377047 - IL (Belleville) (Catholic Charities of So. IL)
00005286 - IL - Chicago
10092399 - IL - Joliet
10163970 - IL - Peoria
00020888 - IL - Springfield
00005269 - IN - Evansville
00005429 - IN - Ft Wayne
00038397 - IN - Gary
10372188 - IN - Indianapolis
00036755 - KS - Dodge City
00036893 - KS - Kansas City (NE Kansas)
00065188 - KS - Salina
00005360 - KS - Wichita
00038399 - KY - Covington
00005425 - KY - Lexington
00036857 - KY - Louisville
10163990 - KY - Owensboro
10163991 - LA - Alexandria
00005423 - LA - Baton Rouge
00058662 - LA - Houma
10370498 - LA - Lafayette
10163993 - LA - Lake Charles
00058220 - LA - New Orleans
10431202 - LA - Shreveport
00035408 - MA - Boston
00074964 - MA - Fall River
10165052 - MA - Springfield
00072210 - MA - Worcester
00005629 - MD - Baltimore
10092778 - ME - Portland
10370483 - MI - Detroit
00036870 - MI - Grand Rapids (West MI)
00005288 - MI - Kalamazoo
00065076 - MI - Marquette (Upper Peninsula)
00038401 - MN - Minneapolis (St. Paul)
10391345 - MN - New Ulm
00012131 - MN - Saint Cloud
00075266 - MN - Winona
10165271 - MO - Jefferson City (Central & Northern MOi)
00038402 - MO - Kansas City
00023372 - MO - Saint Louis
10412461 - MO - Springfield (Southern MO)
10478696 - MP - Karidat Social Services
00036895 - MS - Biloxi
10093276 - MS - Jackson
10165272 - MT - Helena
10142121 - NC - Charlotte
10092401 - NC - Raleigh
00065075 - ND - Fargo
00036979 - NE - Omaha
10165274 - NJ - Camden
00005334 - NJ - Newark
00084093 - NJ - Paterson
00005604 - NJ - Perth Amboy (Metuchen)
10149610 - NJ - Trenton
10145767 - NM - Albuquerque (Santa Fe)
10129581 - NM - Gallup
10370188 - NM - Las Cruces
00005535 - NV - Las Vegas (Southern NV)
10165273 - NV - Reno (Northern NV)
00038403 - NY - Albany
00034792 - NY - Brooklyn
00005008 - NY - Buffalo
00036869 - NY - Hicksville
10093926 - NY - New York
00035407 - NY - Ogdensburg
00036858 - NY - Rochester
10153832 - NY - Syracuse
00064801 - OH - Cincinnati (Southern OH)
00038407 - OH - Cleveland
10162846 - OH - Columbus
00005410 - OH - Dayton (Miami Valley)
10165294 - OH - Steubenville
00034764 - OH - Toledo
00034259 - OH - Youngstown
00033934 - OK - Oklahoma City
00065229 - OR - Portland
00005290 - PA - Allentown
10165296 - PA - Altoona
00065465 - PA - Greensburg
00043538 - PA - Harrisburg
00005301 - PA - Philadelphia
00034228 - PA - Pittsburgh
00038410 - PA - Wilkes Barre (Scranton)
10165327 - PR - San Juan
10165297 - RI - Providence
00035404 - SC - Charleston
00065220 - SD - Rapid City
10136687 - TN - Knoxville (East TN)
00007600 - TN - Memphis
00026447 - TN - Nashville
00005333 - TX - Amarillo
10146072 - TX - Austin (Central TX)
10165318 - TX - Beaumont (Southern TX)
10165320 - TX - Corpus Christi
00005303 - TX - Dallas
00015248 - TX - Fort Worth
00023371 - TX - Houston (Galveston)
10369905 - TX - Laredo
00038411 - TX - Lubbock
10165321 - TX - Odessa (San Angelo)
00005851 - TX - San Antonio
10165319 - TX - San Juan (Brownville)
10369484 - TX - Tyler
00072500 - UT - Salt Lake City
10153534 - VA - Arlington
00005294 - VA - Richmond
00005296 - VA - Virginia Beach
10165328 - VI - St. Thomas
00035023 - VT - Burlington
10092405 - WA - Seattle (Western WA)
00058515 - WA - Spokane
00005417 - WA - Yakima
10165323 - WI - Green Bay
00072637 - WI - La Crosse
10092783 - WI - Madison
10142123 - WI - Milwaukee
00075145 - WI - Superior
00036902 - WV - Wheeling
00005302 - WY - Cheyenne
Not Applicable
Board Member
Employee (branch office)
Employee (main agency)
Volunteer
Select one (optional)
Development and Communications Institute
Finance and Compliance Institute
Financial Empowerment Institute
Human Recources Institute
Public Policy Institute
Retreat-Blessing for Leaders
Social Enterprise Institute
Tracks Available
Track 1 - Advocacy
Track 2 - Direct Service
Track 3 - Immigration
Track 4 - Parish Leadership Development
Not Applicable
10442768 - Catholic Charities of Missouri, LLC
10478366 - Catholic Legal Services Archdiocese of Miami, Inc.
10408108 - Center of Concern
10471047 - Cross Catholic Outreach
10429299 - Dominican Sisters - Grand Rapids
10485935 - Family Crisis Center, Inc.
10416491 - Prefecture Apostolic of the Mashall Islands
10143371 - Society of the Divine Savior
1/16/2014 - agency list last updated (kco)