Male Engagement Institute – North Carolina Head Start Association

Please enable JavaScript in your browser to complete this form.

Male Engagement Institute

Please complete this form to register for the NCHSA Male Engagement Institute.

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Email *

Email

Confirm Email

Grantee *

Your Head Start Agency Name

Job Title *

Your Job Title

Checkbox Items *

Male Engagement Institute - $350.00

Stay Informed

I would like to receive email updates regarding future conferences

{“fields”:{“1”:{“id”:”1″,”type”:”name”,”label”:”Name”,”format”:”first-last”,”description”:””,”required”:”1″,”size”:”medium”,”simple_placeholder”:””,”simple_default”:””,”first_placeholder”:””,”first_default”:””,”middle_placeholder”:””,”middle_default”:””,”last_placeholder”:””,”last_default”:””,”css”:””},”2″:{“id”:”2″,”type”:”email”,”label”:”Email”,”description”:””,”required”:”1″,”confirmation”:”1″,”size”:”medium”,”placeholder”:””,”confirmation_placeholder”:””,”default_value”:false,”filter_type”:””,”allowlist”:””,”denylist”:””,”css”:””},”8″:{“id”:”8″,”type”:”text”,”label”:”Grantee”,”description”:”Your Head Start Agency Name”,”required”:”1″,”size”:”medium”,”placeholder”:””,”limit_count”:”1″,”limit_mode”:”characters”,”default_value”:””,”input_mask”:””,”css”:””},”10″:{“id”:”10″,”type”:”text”,”label”:”Job Title”,”description”:”Your Job Title”,”required”:”1″,”size”:”medium”,”placeholder”:””,”limit_count”:”1″,”limit_mode”:”characters”,”default_value”:””,”input_mask”:””,”css”:””},”28″:{“id”:”28″,”type”:”payment-checkbox”,”label”:”Checkbox Items”,”choices”:{“1”:{“label”:”Male Engagement Institute”,”value”:”350.00″,”image”:””,”icon”:”face-smile”,”icon_style”:”regular”}},”show_price_after_labels”:”1″,”choices_images_style”:”modern”,”choices_icons_color”:”#066aab”,”choices_icons_size”:”large”,”choices_icons_style”:”default”,”description”:””,”required”:”1″,”input_columns”:””,”css”:””,”conditional_logic”:”1″,”conditional_type”:”show”,”conditionals”:[[{“field”:””,”operator”:”==”,”value”:””}]]},”6″:{“id”:”6″,”type”:”checkbox”,”label”:”Stay Informed”,”choices”:{“1”:{“label”:”I would like to receive email updates regarding future conferences”,”value”:””,”image”:””,”icon”:”face-smile”,”icon_style”:”regular”}},”choices_images_style”:”modern”,”choices_icons_color”:”#066aab”,”choices_icons_size”:”large”,”choices_icons_style”:”default”,”description”:””,”input_columns”:””,”choice_limit”:””,”dynamic_choices”:””,”css”:””}},”id”:”3724″,”field_id”:29,”settings”:{“form_title”:”Male Engagement Institute”,”form_desc”:”Please complete this form. An invoice will be sent to your grantee.”,”submit_text”:”Submit”,”submit_text_processing”:”Sending…”,”form_class”:””,”submit_class”:””,”ajax_submit”:”1″,”notification_enable”:”1″,”notifications”:{“2”:{“notification_name”:”NCHSA Conference Registration Notification”,”email”:”{field_id=\”2\”} {admin_email}”,”subject”:”3rd Annual Male Engagement Registration”,”sender_name”:” North Carolina Head Start Association”,”sender_address”:”info@headstartnc.org “,”replyto”:””,”message”:”Thank you for registering to attend our Male Engagement Institute from March 10th, to March 11th, 2025.\r\n\r\nYour registration will be complete once we received payment from your grantee. The hotel link will be made available upon receipt of payment. \r\n\r\nHere is a copy of your submission form.\r\n\r\n{all_fields}\r\n”,”template”:””,”file_upload_attachment_fields”:[],”entry_csv_attachment_entry_information”:[],”entry_csv_attachment_file_name”:”entry-details”},”1″:{“notification_name”:”Default Notification”,”email”:”info@headstartnc.org”,”subject”:”Male Engagement Institute”,”sender_name”:”North Carolina Head Start Association”,”sender_address”:”info@headstartnc.org”,”replyto”:”{field_id=\”2\”}”,”message”:”{all_fields}”,”template”:”classic”,”file_upload_attachment_fields”:[],”entry_csv_attachment_entry_information”:[],”entry_csv_attachment_file_name”:”entry-details”}},”confirmations”:{“1”:{“name”:”NCHSA Registration”,”type”:”message”,”message”:”

Thanks for registering! We will be in touch with you shortly.<\/p>“,”message_scroll”:”1″,”page”:”1140″,”redirect”:””,”message_entry_preview_style”:”basic”}},”antispam”:”1″,”anti_spam”:{“time_limit”:{“duration”:”3″},”country_filter”:{“action”:”allow”,”country_codes”:[],”message”:”Sorry, this form does not accept submissions from your country.”},”keyword_filter”:{“message”:”Sorry, your message can’t be submitted because it contains prohibited words.”}},”post_submissions”:”1″,”post_submissions_title”:””,”post_submissions_content”:””,”post_submissions_excerpt”:””,”post_submissions_featured”:””,”post_submissions_type”:”post”,”post_submissions_status”:”pending”,”post_submissions_author”:””,”registration_username”:””,”registration_email”:”2″,”registration_name”:”1″,”registration_password”:””,”registration_website”:””,”registration_bio”:””,”registration_role”:”subscriber”,”registration_activation_method”:”user”,”registration_email_user_activation_subject”:”{site_name} Activation Required”,”registration_email_user_activation_message”:”IMPORTANT: You must activate your account before you can log in.\r\nPlease visit the link below.\r\n\r\n{url_user_activation}”,”registration_activation_confirmation”:””,”registration_hide_message”:”Hi {user_first_name}, you\u2019re already logged in. Log out<\/a>.”,”registration_email_admin”:”1″,”registration_email_admin_subject”:”{site_name} New User Registration”,”registration_email_admin_message”:”New user registration on your site {site_name}:\r\n\r\nUsername: {user_registration_login}\r\nEmail: {user_registration_email}”,”registration_email_user_subject”:”{site_name} Your username and password info”,”registration_email_user_message”:”Username: {user_registration_login}\r\nPassword: {user_registration_password}\r\n{url_login}\r\n\r\n”,”registration_email_user_after_activation_subject”:”{site_name} Your account was successfully activated”,”registration_email_user_after_activation_message”:”You can log in with your credentials now.\r\n\r\n{url_login}”,”form_pages_enable”:”1″,”form_pages_title”:”Male Engagement Institute”,”form_pages_description”:”Please complete this form to register for the NCHSA Male Engagement Institute.”,”form_pages_page_slug”:”male-engagement-3724″,”form_pages_custom_logo”:”3736″,”form_pages_footer”:””,”form_pages_brand_disable”:”1″,”form_pages_color_scheme”:”#448ccb”,”form_pages_style”:”modern”,”form_tags”:[],”store_spam_entries”:”0″},”search_terms”:””,”providers”:{“google-sheets”:[]},”meta”:{“template”:”be32b8cc1eb80419086b4b282acf6d4b”}}