REGISTRATION FORM - High Income Country Delegate
DELEGATE DETAILS

Full Name: *
Name on Badge (Limited to 15 characters): *
Designation / Position: *
Place of Practice/ Work/ Study : *
Address : *
City : *
State : *
Country : *
Postal Code : *
Email : *
Fax :
Tel. (Office) : *
Mobile:

Are you participating in any oral/ poster presentations? Yes No

 

Special diet preference No
- Gluten-free Yes
- Vegetarian Yes
- Vegan Yes

REGISTRATION FEES (Please Tick the Appropriate box)

Category: Early bird Registration:
1st December, 2016 to 31st May 2017		 Late bird Registration:
1st June to 1st July, 2017
IASP Members: USD 610 USD 640
Non-Members: USD 640 USD 690

PRECONFERENCE WORKSHOPS (Please Tick the Appropriate boxes)

No.: Workshop: Fee
0. Not interested USD 0
1. Restricting access to means of suicide USD 150
2. Preventing suicide among children and youth USD 150
3. Gatekeeper training: RELEASE Model and Active Listening Skills USD 150
4. Psychological autopsy USD 150
5. Suicide helplines USD 150
6. Psychological therapies for people at risk USD 150
7. Social media and suicide USD 150
8. Psychodynamic Psychotherapy USD 150

ACCOMPANYING PERSON (Please Tick the Appropriate box)

No.: Day(s): Fee
0. Not interested USD 0
1. 1 day. USD 80
2. 2 days USD 160
3. 3 days USD 240
4. 3 1/2 days USD 280


Please choose payment method: (Please note: ALL FEES ARE INCLUSIVE OF 6% GOODS AND SERVICES TAX (GST))

Payment by Paypal / Credit Card
Payment by Local Purchase Order / Cheque / Bank Draft / Telegraphic Transfer