Contact Details

Salutation

Name

First

Last

Suffix

Email

Home Phone

Work Phone

Cell Phone

Preferred Contact Method

Phone
Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Year of Birth

Faith Tradition

Other Faith Tradition (please specify)

Denomination

Other Denomination (please specify)

Questions About You

Are you affiliated with a religious congregation?

What is the name of the religious congregation where you participate?

Do you have any prior experience with interfaith learning or dialogue?

How has your experience of faith/spirituality intersected with the theme of race or racial justice in your life?

How has your experience of gender impacted or been shaped by your experience of faith/spirituality?

Think about what you hope to experience through this program, and set 1-3 goals for yourself.

Tell us a little about yourself! You can include your occupation, skills, and/or interests.

All sessions are 2:00 - 5:00 p.m. except the Orientation/Welcome session which is 3-5pm.

Sunday January 11 Orientation (online)
Sunday January 25 Christian (Historic St. George's)
Sunday February 8 Muslim (Islamic Society of Greater Valley Forge)
Sunday March 15 Hindu (BAPS Swaminarayan Akshardham)
Sunday April 19 Jewish (South Philadelphia Schtiebel)
Sunday May 17 Indigenous (Blue Bell Park)

Please check which sessions you will attend

Please check each box to acknowledge the following:

I commit to watching the recording of the online orientation if I can not attend it live.
I understand this is a growth opportunity. I will meet people with different theological beliefs than my own.
I will not denigrate any other participants because of their beliefs.
I will not proselytize.

Do you have any questions/comments/additional information for us that can support you in your participation?

Do you have a friend you think would be interested, drop their email address below.

Please check:

I give my permission to include my name and email in the Visionary Women directory that will be shared with all participants.
By registering for this program, THE UNDERSIGNED, for himself/herself, his/her personal representatives, heirs, and next of kin, and minors for whom he/she is the parent or guardian ACKNOWLEDGES, AGREES, AND REPRESENTS THAT HE/SHE GRANTS PERMISSION for Interfaith Philadelphia, and their program and media partners to USE ANY PHOTOS, FILM, VIDEOS OR TAPES, ART WORK, AND WRITING of the participant in any documentation, publication, broadcasting, and publicity of its activities.

Program Fees ($200 suggested cost)

Interfaith Philadelphia is committed to making our programs accessible to all. The suggested price of this program is $200 with a sliding scale of $50-$395. For more information on how to determine the cost that is right for you, go to: https://www.interfaithphiladelphia.org/slide-scale-fee-structure/

Minimum Price: $50.00

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