Name(Required) First Last Organization Name(Required)Email(Required) Phone(Required)Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Other location (if not in the United States)Event Information(Required)Tell us about your event (who is the audience, expected size, venue, etc.) What topics or issues are most important to your audience? Tend Deep Tend Fostering Well-being Practicing Care in the Workplace visionSPARK On Mission On Purpose Getting Wholehearted The Resilience Reset Thinking Big from the Trenches Something else/ Not sure/ Let’s talk about it Format Zoom In-Person Who referred you?/How did you hear about Rosie?(Required)CAPTCHA