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Registration Form
Registration form for the 5th Continental CBR/CBID Congress of the Americas
October 25-27, 2022
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* Indicates required question
Email
*
Your email
First name
*
Your answer
Last name
*
Your answer
E-mail address
*
Your answer
Contact number
Your answer
Sex
*
Male
Female
Other:
Country
*
Choose
Andorra
United Arab Emirates
Afghanistan
Antigua and Barbuda
Anguilla
Albania
Armenia
Netherlands Antilles
Angola
Antarctica
Argentina
American Samoa
Austria
Australia
Aruba
Azerbaijan
Bosnia and Herzegovina
Barbados
Bangladesh
Belgium
Burkina Faso
Bulgaria
Bahrain
Burundi
Benin
Bermuda
Brunei
Bolivia
Brazil
Bahamas
Bhutan
Bouvet Island
Botswana
Belarus
Belize
Canada
Cocos [Keeling] Islands
Congo [DRC]
Central African Republic
Congo [Republic]
Switzerland
Côte d'Ivoire
Cook Islands
Chile
Cameroon
China
Colombia
Costa Rica
Cuba
Cape Verde
Christmas Island
Cyprus
Czech Republic
Germany
Djibouti
Denmark
Dominica
Dominican Republic
Algeria
Ecuador
Estonia
Egypt
Western Sahara
Eritrea
Spain
Ethiopia
Finland
Fiji
Falkland Islands [Islas Malvinas]
Micronesia
Faroe Islands
France
Gabon
United Kingdom
Grenada
Georgia
French Guiana
Guernsey
Ghana
Gibraltar
Greenland
Gambia
Guinea
Guadeloupe
Equatorial Guinea
Greece
South Georgia and the South Sandwich Islands
Guatemala
Guam
Guinea-Bissau
Guyana
Gaza Strip
Hong Kong
Heard Island and McDonald Islands
Honduras
Croatia
Haiti
Hungary
Indonesia
Ireland
Israel
Isle of Man
India
British Indian Ocean Territory
Iraq
Iran
Iceland
Italy
Jersey
Jamaica
Jordan
Japan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Comoros
Saint Kitts and Nevis
North Korea
South Korea
Kuwait
Cayman Islands
Kazakhstan
Laos
Lebanon
Saint Lucia
Liechtenstein
Sri Lanka
Liberia
Lesotho
Lithuania
Luxembourg
Latvia
Libya
Morocco
Monaco
Moldova
Montenegro
Madagascar
Marshall Islands
Macedonia [FYROM]
Mali
Myanmar [Burma]
Mongolia
Macau
Northern Mariana Islands
Martinique
Mauritania
Montserrat
Malta
Mauritius
Maldives
Malawi
Mexico
Malaysia
Mozambique
Namibia
New Caledonia
Niger
Norfolk Island
Nigeria
Nicaragua
Netherlands
Norway
Nepal
Nauru
Niue
New Zealand
Oman
Panama
Peru
French Polynesia
Papua New Guinea
Philippines
Pakistan
Poland
Saint Pierre and Miquelon
Pitcairn Islands
Puerto Rico
Palestinian Territories
Portugal
Palau
Paraguay
Qatar
Réunion
Romania
Serbia
Russia
Rwanda
Saudi Arabia
Solomon Islands
Seychelles
Sudan
Sweden
Singapore
Saint Helena
Slovenia
Svalbard and Jan Mayen
Slovakia
Sierra Leone
San Marino
Senegal
Somalia
Suriname
São Tomé and Príncipe
El Salvador
Syria
Swaziland
Turks and Caicos Islands
Chad
French Southern Territories
Togo
Thailand
Tajikistan
Tokelau
Timor-Leste
Turkmenistan
Tunisia
Tonga
Turkey
Trinidad and Tobago
Tuvalu
Taiwan
Tanzania
Ukraine
Uganda
U.S. Minor Outlying Islands
United States
Uruguay
Uzbekistan
Vatican City
Saint Vincent and the Grenadines
Venezuela
British Virgin Islands
U.S. Virgin Islands
Vietnam
Vanuatu
Wallis and Futuna
Samoa
Kosovo
Yemen
Mayotte
South Africa
Zambia
Zimbabwe
Native Language
Choose
English
Spanish
French
Portugese
Age
*
Your answer
Will you be attending the
5th Continental CBR/CBID Congress of the Americas 2022
in person or virtually?
*
I will be attending in person
I will be attending in virtually
Are you a representative of an Organisation(s), Institution, NGO etc?
Your answer
What is your function as it relates to CBR/CBID strategy?
Choose
OPD leader
Field worker
Protect team
Administrator
Government
Parent
Will you be attending as a (select all that apply)
*
Presenter
Representative of an organisation
Individual Participant
Required
Do you identify as a person with a disability?
*
Yes
No
Do you require any type of accomodation/assistance?
Choose
Sign language interpreter
Hearing assistive device
Audio description
Braille menu
Video description
Assistance for mobility issues
Accessible transportation
What type of disability do you have? (question to ensure accommodations are provided)
*
Your answer
If attending in person and have a disability, will you be accompanied by a care giver or parent?
Yes
No
Clear selection
If attending in person, do you have any dietary restrictions or food allergies?
*
Your answer
If you are staying at a hotel, please select from the options below.
Royalton -
www.Royaltonresorts.com
(268) 484-2000
Hawksbill-
https://hawksbillbyrexresorts.com/
(268) 462-0301
Heritage Hotel-
www.heritagequayhotel.com
(268) 481-7531
Galley Bay-
https://www.eliteislandresorts.com/
(268) 462-0302
Clear selection
How did you hear about this event?
Social Media
E-mail
Referral
Flyer
Other:
Clear selection
What do you hope to gain from the Congress?
New knowledge about CBR/CBID
Best practices in CBR/CBID
Networking
Sharing experiences and information
Fun
Other:
Is there any aditional information you would like to provide?
Your answer
Submit
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