summit 2025 payment page LEADERSHIP SUMMIT 2025 – PAYMENT AND REGISTRATION FORM Name* First Last Email* Cell Phone (for conference related questions)*HiddenPlease click here so that you receive all necessary conference information. Yes, I would like to subscribe Conference DirectoryWe plan to share a directory of conference participants (printed or emailed PDF, not posted online) which will serve as a valuable resource for you to network with women involved in similar communal work. Please enter the information below as you would like it to be printed in the directory. Please check that all spelling and contact information is correct.Name as you would like it to appear in the directory:* First Last Email to include in directory* Cell phone to include in directory*Location to include in directory* City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country My communal involvement*We look forward to sharing the remarkable impact our group is making on the broader community. Please share up to 5 areas of communal involvement. Click the + to add entries. (Please spell check.)Name of organizationMy role or title Please share a brief description of up to 3 organizations you’re involved with. Each entry should contain only one organization's name and description—submit multiple organizations as separate entries.Organization #1: name and description I would like to add a second organization* Yes No Organization #2: name and description I would like to add a third organization* Yes No Organization #3: name and description Thumbnail picturePlease upload a picture so that women can put a face to a name and build community.Max. file size: 512 MB.Initiatives for IsraelAt the summit, we look forward to sharing the scope of impact our group and their communities have made post-October 7th. Please share up to 3 initiatives you have been involved with (enter each initiative separately)Initiative #1 I would like to add a picture or short video clip of this initiative (#1)Max. file size: 512 MB.Initiative #2 I would like to add a picture or short video clip of this initiative (#2)Max. file size: 512 MB.Initiative #3 I would like to add a picture or short video clip of this initiative (#3)Max. file size: 512 MB.Networking SessionsOne of our networking discussions will center around navigating leadership challenges together. Are you currently facing a question or challenge you would like to discuss in a small group setting?If so, please share a few questions you would like to discuss. Additional CommentsComments: OU consentMedia Release* By checking this box, I acknowledge and represent that I am at least eighteen (18) years of age and that I have read the THE ORTHODOX UNION MEDIA RELEASE, and that I understand it and sign it voluntarily. ORTHODOX UNION MEDIA RELEASE From time to time, The Union of Orthodox Jewish Congregations of America, and its programs, employees and agents (together, the “Orthodox Union”) take photographs and videos of individuals, including minors, who attend or participate in Orthodox Union events, programs, and other offerings. The Orthodox Union engages in these activities for purposes relating to the advancement of the religious, spiritual, charitable, and educational goals and objectives of the Orthodox Union, including but not limited to the sharing of photos/videos in newsletters, on our blogs, and on our website and social media pages for the purpose of keeping our members and others informed of the Orthodox Union’s events and other activities. Please complete this form to give us permission to take photos/videos of you and/or your children when you participate in Orthodox Union events or programs and to use those photos/videos in our printed and online publicity: I hereby authorize the Orthodox Union to take photographs and/or video of me (or my children) when I (or my children) participate at Orthodox Union events or programs. I grant the Orthodox Union full rights to use and share the images resulting from the photographs and/or videos and any reproductions thereof (the “Recording”), in whole or in part, along with my (or my children’s) name, biographical information and quotations for any purpose including fundraising, publicity, advertising, or on social media, all without further obligation or compensation. I hereby waive any right of review or approval regarding the Recording and the Orthodox Union shall have the right to edit or delete the Recording in its sole discretion. I understand that all rights in and to the Recording shall be the Orthodox Union’s sole and absolute property. I understand that if I access the Orthodox Union’s services through a third party platform, product, service, or application (a “Third Party Service”), content and related information generated while accessing OU’s services in this manner may be monitored, captured, and or recorded by the third parties that provide such Third Party Services. I consent to the use and sharing of personal information by any such third party as described in the privacy policy available through the Third Party Service. I release and forever discharge the Orthodox Union from all causes of action, suits, or liability of any kind arising from or in connection with the use or publication of any Recording of me or my children made in connection with my participation in Orthodox Union events. I waive any right of privacy associated with the Recording and I waive any right to compensation related to the use of the Recording. I HAVE READ THIS AGREEMENT AND AM FULLY AWARE OF ITS CONTENTS, INCLUDING THE RELEASE THAT I HAVE AGREED TO HEREIN. I warrant that I am at least eighteen years of age (or, if not, that my parent or legal guardian has agreed to the foregoing and signed below) and that I have the full and unrestricted authority to enter into a contract for myself (or, if not, that my parent or legal guardian has agreed to the foregoing and signed below). If any provision of this agreement is held to be unenforceable, the remainder of it shall continue to be in full force and effect. This waiver shall remain in effect until such time as I advise the OU otherwise in writing. PaymentRegistration Fee*This includes: conference sessions, meals, and special programs, and a hotel room on Monday evening May 5 (your own room). Please note that this conference is highly subsidized by the OU Women's Initiative. Standard Fee - $575.00 I will share a room with a friend Monday evening for a discounted rate of $500.00 I will not be staying at the hotel on Monday evening - $450.00 Name of friend:*Please note: you and your friend must submit your payment forms within 5 business days of each other in order to secure your room and discounted rate. Coupon code (staff) Sunday evening May 4*We welcome you to join us at the hotel on Sunday evening beginning at approximately 7:00 PM. We will provide a light boxed dinner. The additional cost is $185. I will arrive Monday morning at the beginning of the conference (I am not staying over Sunday evening). I would like to arrive on Sunday evening May 4, for an additional $180. Total $0.00 Consent* I understand that if this reservation is canceled before April 21, 2025, 50% of the fee is refundable. Beginning April 22, 2025, no part of this fee is refundable.