Wufoo

Application Deadline

Applications are due on Monday, April 3, 2017 at 5:00 pm Eastern Daylight Time.
Your Name * Title First Last Suffix
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone Number * ### - ### - ####
Additional information about you - Are you a (Check all that apply) *
Member of a Conservative kehilla (synagogue)? Clergy Member or Professional at a Conservative kehilla? USY Alum(na)? Camp Ramah Alum(na)? Solomon Schechter Day School Alum(na)? None of the above
Please tell us which kehilla you belong to and/or which organization you represent.
Kehilla or Organization's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
How did you learn about the 2017 USCJ Convention? *
Email communication from USCJ Social media communication from USCJ Visit to the USCJ website Visit to the USCJ Convention website Contact with my KRM (Kehilla Relationship Manager) Other
If you checked "Other," please specify.
Did you attend the USCJ Convention in 2015? *
Yes No
Were you a presenter at the USCJ Convention 2015? *
Yes No
Your Proposal

Please describe your session from the standpoint of what participants will know, do and feel. All sessions must include tools for participants to take home and take action. Tell us what tools you will provide.
Proposed Session Title *
Description of Session. (150-250 words) Be sure to explain:
1. How the session will be interactive and experiential
2. What tools and strategies participants will learn
3. How your session will help participants continue the work when they return home *
Must be between 150 and 250 words. Currently Used: 0 words.
Here is a link to an article, video or another platform that would help advertise my session or thriving story from my congregation.
Name of Other Presenters (If Applicable)
I would be comfortable making my presentation in any of the following presentation formats (check all that apply) *
Single Presenter Workshop Multi-Presenter Workshop Member of a Panel Discussion Table Talk during a Convention Meal
Which day(s) would be best for you to present at the convention? (check all that apply) *
Sunday- December 3, 2017 Monday- December 4, 2017 Tuesday- December 5, 2017
Should your proposal be accepted, would you like to write a blog post or thought piece for the convention website? *
Yes No
Should your proposal be accepted, would you like to record a video on YouTube or another format for the convention website? *
Yes No
Presenter(s) Photo and Biography

USCJ requires that all presenters provide a photograph and biography in order to submit a completed application. Additional space is provided for additional photographs and biographies if the proposal includes multiple presenters.
Please upload a photograph of yourself to be published on the convention website and in the convention brochure if your proposal is accepted. *
Please write a short biography of yourself to be published on the convention website and in the convention brochure (50 Words or Less) if your proposal is accepted. *
Maximum Allowed: 50 words. Currently Used: 0 words.
Please upload an additional photograph if proposal includes multiple presenters.
Please upload an additional photograph if proposal includes multiple presenters.
Please write an additional biography to be published on the convention if your proposal includes multiple presenters (50 Words or Less).
Maximum Allowed: 50 words. Currently Used: 0 words.
Please write an additional biography to be published on the convention if your proposal includes multiple presenters (50 Words or Less).
Maximum Allowed: 50 words. Currently Used: 0 words.
Presenter Agreement

In submitting this proposal for the 2017 USCJ Convention, please note that you are agreeing to each of the following – please check each clause to confirm your agreement:
Should you be selected to be a presenter, you will be responsible for the costs of your transportation to/from the conference, your hotel stay, and payment of the full conference/Shabbaton registration fees (as applicable). *
I Agree
USCJ (including its staff and volunteers) has full discretion to choose the workshops, presenters and participants in the 2017 USCJ Conference. There is no guarantee that this proposal will be accepted. It is understood that the presenters for the 2017 USCJ Convention will be selected on the basis of gender, sexual orientation, geography, backgrounds and institutional affiliations to allow USCJ to showcase a mosaic of outstanding leaders, professionals, and kehillot. *
I Agree
Should your proposal be selected, or should you be selected to be a presenter, the biography, picture description included with this proposal will be used in the convention program, and any of these materials may be edited by USCJ in its full discretion. *
I Agree
Should your proposal be selected, or should you be selected to be a presenter, you agree that your image and presentation may be included in photos, videos and sound recordings produced prior to or during the USCJ convention, whether for purposes of promoting or reporting on the convention, or for such other use as USCJ may determine in its absolute discretion, and that such photos, videos and sound recordings may be used in print, on the Internet, or in other media produced by USCJ for publicity, promotional or any other purposes, without further permission. *
I Agree
Do Not Fill This Out

Wufoo

Application Deadline

Your Proposal

Presenter(s) Photo and Biography

Presenter Agreement