For the first time in history, multiple Friendship Circles will be collaborating to create an event for the prestigious leaders of Friendship Circle to learn about leadership and to gain an understanding of what it means to be a leader in Friendship Circle. The event will take place at Friendship Circle of 5 Towns on February 23, 2020 from 5PM-7:45PM. Your FC Director will arrange transportation with you. Please take the time to complete this form so that you can gain the most from this incredible event. Leader Information Full Name:* First Name Last Name E-mail:* Cell Phone Number:* Area Code Phone Number Gender:* Female Male Grade:* School* Which Friendship Circle are you part of?* Five Towns Great Neck Dix Hills Roslyn Fairfield County Upper East Side Allergies: Parent Information Full Name:* First Name Last Name E-mail:* Cell Phone Number:* Area Code Phone Number Your Say! List 3 things you would like to gain out of this training:* Do you have any Friendship Circle related questions that you would like addressed:* Do you have a topic you would like to present?* Yes No If yes, describe what you would like to present and how: What is your favorite part of being a FC President?* Is there anything else you would like to share ahead of the training day?* Payment The cost of this program is $30. (NOT INCLUDING TRANSPORTATION) Payment* Credit Card Other Credit Card Visa MasterCard American Express Discover Credit Card Type Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Expiration Year I would like to pay at the event Billing Address Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Total $0.00 THANK YOU SO MUCH! We are looking forward to creating a wonderful event with your involvement. For any Qs or concerns, contact Rocheli at 917.912.7641 or [email protected] Submit Should be Empty: This page uses TLS encryption to keep your data secure.