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1. Name

First Name: *

Middle Name, Middle Initial and/or Maiden Name:

Last Name: *

Account information

Username: *

Your full name or your preferred username; only letters, numbers and spaces are allowed.

E-mail address: *

A password and instructions will be sent to this e-mail address, so make sure it is accurate.

2. Affiliation

Affiliation / Company / Organization:

3. Contact Information

Street Address:

The content of this field is kept private and will not be shown publicly.

City:

The content of this field is kept private and will not be shown publicly.

State:

The content of this field is kept private and will not be shown publicly.

ZIP Code:

The content of this field is kept private and will not be shown publicly.

Phone Home/Cell:

The content of this field is kept private and will not be shown publicly.

Phone Business/Daytime:

The content of this field is kept private and will not be shown publicly.

Website:

4. Idea Round Up

Participation:

Did you participate in the Idea Round Up on September 9th at CAPA?

Room Number:

If you participated in the Idea Round Up on September 9th, which room number did you participate in?

Engage Pittsburgh is a program of The Sprout Fund, a project of the Tides Center (PA), and is supported by lead contributions from the Claude Worthington Benedum Foundation and the Richard King Mellon Foundation.

Additional support for Engage Pittsburgh is provided in part by the Alcoa Foundation, Eden Hall Foundation, Grable Foundation, the Elsie Hillman Foundation, Jewish Healthcare Foundation, and the Pittsburgh Foundation.

The contents of the Engage Pittsburgh website and the ideas and projects discussed herein are licensed under a Creative Commons Attribution 2.5 License. Usage is permitted so long as content, ideas, and images are properly attributed to their original authors and this project.

Creative Commons License

The comments and opinions expressed herein are solely those of their authors and do not necessarily reflect the official views of The Sprout Fund, the Tides Center (PA), program funders, or of the entities, companies, and organizations affiliated with individual users.