Conference Registration Form
First Name *
Your answer
Last / Family Name *
Your answer
Country of Residence *
Your answer
Nationality/ies *
Your answer
Age *
Your answer
Gender *
Your answer
Other identities
Your answer
Occupation
Your answer
Job Title / Role at Work *
Your answer
Name of Organization / Place of Work *
Your answer
What does your organization do?
(Short sentence describing the main task of the organization)
Your answer
Mobile Phone *
Your answer
Preferred Email *
Your answer
Home Address *
Your answer
How did you hear about the conference? *
If other, please describe
Your answer
Previous Group Relations Experience *
(This question refers to residential Group Relations conferences not other group work or training)
Required
Please fill in details of past conferences
Year, title of conference, duration, sponsoring organizations
Your answer
Topics you would like to work on in the conference, if any
Your answer
I would like a single room / shared occupancy *
If shared occupancy I would like to share a room with:
If no name is given the conference administration will assign a roommate for you.
Your answer
Dietary restrictions
Your answer
Requests / Remarks
Your answer
Registration will be completed after making your payment – please check the box with your preferred method of payment. *
Required
If other - please add information about payment method
Your answer
Joint Registration
Name(s) of joint registrants
Your answer
Discounts
Details that may be shared with conference participants: Name, Occupation or Job Title/Role at Work, Place of Work, Country of Residence. *
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Thank you for filling out the registration form.
For additional information or if you have any questions please contact Smadar Ashuach or Amir Scharf at ofekgrc@gmail.com
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