Come to the Table Conference Registration

Registration Form

Come to the Table Conference (Eastern Region)
Date: Friday, January 23, 2015
Time: 8:00 a.m. - 4:00 p.m.
Venue: Southeastern North Carolina Agricultural Events Center
1027 U.S. Highway 74 East
Lumberton, NC 28358
Full Name *

First Name Last Name
Email Address *

Confirmation Email
Phone Number *
Mailing Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Gender:
Race/Ethnicity
Have you attended a Come to the Table Conference in previous years? *

Yes No
Are you a speaker, keynote, or a special guest?

Yes No
Organization:
Role in Organization:
Religious Affiliation / Denomination:

Baptist Buddhist Catholic Episcopal Islam Jewish Lutheran Mennonite Methodist Presbyterian Quaker Unitarian
Type of Program:

Backpack Community or Free Meal Community Garden Education Farm Farmer's Market Food Pantry Gleaning
Dietary Restrictions:

Gluten Free Vegan Vegetarian Nut Allergy
How did you hear about the conference?

The Duke Endowment Friend or Relative Church Work Media (Newspaper/Radio) Flyer or Ad Internet search
Preferred Payment Method: *
Registration Option *

Registration Fee $20.00 Vendor Table Fee $50.00 Tax Deductible Donation (Thank You) $20.00
Scholarships: Please contact us for scholarship opportunities. You can send an email to cttt@rafiusa.org.

Vendor Note: If you are interested in becoming a vendor for our Come to the Table Conference, please send an email to cttt@rafiusa.org. You will need to be approved before we can accept your vendor registration.
Thank you
Sub Total
Discount Code
Total

CREDIT PAYMENT SELECTIONS

USD Registration

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Check Payments:
Make all checks payable to the Rural Advancement Foundation International - USA and write in the memo section "CTTTC along with the Attendee's Name".

Mail to: PO Box 640, Pittsboro, NC 27312
*Refund Policy: Conference payment is non refundable.
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