Conference Registration Form
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First Name *
Last / Family Name *
Country of Residence *
Nationality/ies *
Age *
Gender *
Other identities
Job Title / Role at Work *
Name of Organization / Place of Work *
What does your organization do?
(Short sentence describing the main task of the organization)
Mobile Phone *
Preferred Email *
Home Address *
How did you hear about the conference? *
If other, please describe
Previous Group Relations Experience *
(This question refers to residential Group Relations conferences not other group work or training)
Please fill in details of past conferences
Year, title of conference, duration, sponsoring organizations
Topics you would like to work on in the conference, if any
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.
Dietary restrictions
Requests / Remarks
Registration will be completed after making your payment – please check the box with your preferred method of payment. *
If other - please add information about payment method
Joint Registration
Clear selection
Name(s) of joint registrants
Clear selection
Details that may be shared with conference participants: Name, Occupation or Job Title/Role at Work, Place of Work, Country of Residence.           *
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
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