Domestic Violence Employer's Training Workshop Registration

Registration Form

Number of Attendees at $120 each (Includes breakfast, lunch and parking at Hearst Tower) *
Guest 1 First Name *
Last Name *
Email address *
Title/Role *
Guest 2 First Name
Last Name
Email address
Guest 3 First Name
Last Name
Company *
Phone *

Please enter your Contact Information

First Name *
Last Name *
Email *
Phone *
Address *
Country *
City *
State/Province *
Zip/Postal *

Please enter your Billing Information

We accept the following cards
Name on Card *
Card Number *
Card Expiration Date *
Card Verification Value (CVV) *
(what is this?)
Same as Contact Information
Billing Address *
Country *
City *
State/Province *
Zip/Postal *
If an alternative form of payment is needed, please contact Susan Ross at
704-661-2865 or 

Where is your organization with regard to Domestic Violence? *
Do you have a Domestic Violence Policy you are willing to share? *
Upload your DV policy here

Workshop Topics: Please rank in order of importance with 1=Low 9=High

Current State of Domestic Violence in our City/Region. *
Awareness Campaigns *
In-House Support Teams *
Creating a Domestic Violence Policy *
Leveraging Current HR Programs/Benefits *
Legal/Security and Employee Services *
Business Case/Metrics/Tracking Success *
Executive Communication/Engagement *
Community Resources/Partners *
Other topics or goals you have for attending the workshop:

How many employees does your organization have *

Options for Lunch - please select one per guest

  1. Grilled Chicken Cobb Salad: mixture of lettuce topped with grilled chicken, tomatoes, apple-wood smoked bacon, eggs, avocado, chives and Roquefort blue cheese crumbles tossed in Dijon-vinaigrette
  2. Buddha Bowl Salad: crispy chickpeas, quinoa, fresh herbs and spices, red pepper sauce
  3. Turkey Club Wrap: roast turkey, apple-wood smoked bacon, cheddar cheese, lettuce, tomato and honey mustard
  4. Italian Hoagie: ham, salami, pepperoni and provolone cheese with shredded lettuce, tomatoes, and oil-vinegar

Guest 1: *
Guest 2:
Guest 3:
Do you have any dietary restrictions? *


Employer Workshop Sponsors

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