Otherwise, please print out, complete, and return to:

Please complete this application form and return to Interfaith Funders via fax by June 7, 1998. The fax # is 516-364-8922.

Address__________________________________City_______________State_______ZIP_______

E-mail_______________________________________

B. Your Organization's Name________________________________________________________

Address__________________________________City_______________State______ZIP______

E-mail___________________________________

Annual Budget______________

Number of staff _____________

In order to achieve gender and race/ethnic diversity among the participants in the Working Group, we ask that you provide the following information.

C. Gender

� Male

� Female

D. Ethnicity/Race:

� Black/African American

� Asian or Pacific Islander

� American Indian or Alaskan Native

� White

� Hispanic (persons of Spanish culture or origin, regardless of race)

E. Please describe why you are interested in participating in the workshop:

 F. What would you like to accomplish at the Working Group?

(Note: Please also complete and return to UC Davis the advance registration form for the Collective Behavior and Social Movement workshop, and, if you wish, the University Accommodations form)