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Renaissance Module Request Form

Please complete this form if you want to host a Renaissance module at your congregation, district, or other organization. To ensure appropriate publicity, please submit this form at least six months before the module is to be presented.

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	*	required fields
Your Name:	*
Your Email:	*
Module Title:	*
Website (URL):
Start Date:	*
End Date:	*
Registration Deadline:
Location:	*
Address:	*


District:	*
Sponsoring Group:	*
Coordinator Central contact with the Renaissance Program Office at the Unitarian Universalist Association; he or she gathers all pertinent information from the Registrar, Leader, and Co-leader.
Name:	*
Email:	*
Address:


Phone (h):
Phone (w):
Registrar
Name:	*
Email:	*
Address:


Phone (h):
Phone (w):
Leader
Name:
Email:
Address:


Phone (h):
Phone (w):

Co-Leader
Name:
Email:
Address:


Phone (h):
Phone (w):
Please specify where display materials should be sent:
		Module location
		Coordinator
		Registrar
		Other (please specify):

Please specify where the readers should be sent:

You will receive an email confirmation of your submittal from the Religious Education Credentialing Director within the next seven days.

For more information contact recredentialing @ uua.org.

Last updated on Tuesday, December 2, 2008.