ONLINE REGISTRATION FORM

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* Required information.

Participant information

First Name *
Surname *
Function *
Organization *
Address *
Place
Country
E-mail *
Telephone number *
Telephone number 2

Which one of the program days will you attend (or Thursday November 5, 2015 or Friday November 6, 2015) both days have the same program.   

Choose a date *
I will attend on Thursday November 5, 2015
I will attend on Friday November 6, 2015

Registration fee USD 25   

Choose an option *
I will pay the USD 25 by check in-advance (at MHF)
I will pay the USD 25 in cash in-advance (at MHF)
I will pay the USD 25 by check at the door
I will pay the USD 25 by check in-advance
I will make an Online back transfer to WIB account # 21.47.48.03 under the name of Mental Health Foundation stating Mental Health Conference and name of the participant(s) (before November 1, 2015)

What is included in the registration free

Note bloc, pen + program booklet

Coffee, tea and snacks during breaks

Lunch

 

Which lunch meal would you like? *
Chicken
Fish
Vegetarian
I hereby agree with terms of agreement. *
Copyright 2011 ONLINE REGISTRATION FORM. MHF | Leopard Rd #1, Cay Hill, St. Maarten | Phone: +1721-5421677 | Emergency: +1721-5205556 |
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