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Conference Registration

Welcome to registration for the

Annual International Commemoration
of
World Elder Abuse Awareness Day

We appreciate your interest in overcoming elder abuse in our world, and your support at this conference.
A Full Day Forum on May 28, 2012
 
at the
 
ZIVOT 90 Theater
 
Prague
 


Delegates can complete the Registration form below
then pay the conference fee on line using the DONATE button on INPEA's Home Page
or indicate that payment will be made on arrival at the conference on May28th
|| INPEA/Zivot 90/IFA Members - $29USC/569Czk /€21 || Non-Members $53US/1040Czk/€37 ||
Conference fee includes tea breaks and lunch.
Thank you.
Name Prefix
(Mr, Mrs, Ms, Dr,
or other-optional)
First
Name
Middle
Initial		 Last
Name		 Name Suffix
(Sr, Jr, II, III,
PhD or other)
Organization Name
Job Title/Position
e-mail
(Required for confirmation)
Street/Mailing
Address
(2 lines max.)

City
State/Provence Postal-Zip
Country
Telephone

FAX
(Country Code.AreaCode.Phone# - Ext.) (Country Code.AreaCode.Phone# - Ext.)
- - - - -
Membership Information
Yes
No
I am / my organisation is an INPEA,  Zivot  90 or IFA  Member
If Yes, Member no (where  applicable)
 
I wish to apply for INPEA membership:
Individual: $50 USD (developed countries) or $25 USD (undeveloped countries)

Special Conference offer

.
Members of INPEA, Zivot 90 or IFA 
conference fees
at a reduced rate of $29 USD or 569CZK or €21

 
- - - - -
Conference Fee Arrangements
(Also includes tea break & lunch)
Member Booking $29 US 569CZK  €21
Non-member Booking $53 US 1040CZK  €37
Payment will be made on arrival at conference May 28th

(These arrangements include Conference Fee
plus any membership fee that may apply.)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Thank you for answering the following few question about attending the conference, WEAAD, and INPEA. (Optional)
Do you require a special meal for the luncheon?
 No Kosher     Vegetarian    Other Meal
Do you have any special needs?
 No If Yes, a brief description please. We will try to accommodate you within our ability.
Are you familiar with the World Awareness Day?
 Yes No
Have you attended any of the prior GLOBAL WEAAD Events?
If so, how many (1, 2, 3, 4, 5)?
 No
1 2 3 4 5
Have you attended or held WEAAD events in your local area?
 Yes No
Do you wish to be added to the INPEA E-Bulletin e-Mailing?
 Yes No
- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
We appreciate your interest in WEAAD.
Please review your entries, then click the Submit button only once.
Please wait several seconds for the transaction to be processed.
Click "submit"  to register
Haga clic aquã para registrarse
Cliquez sur ici pour s'enregistrer
Thank you - Gracias - Merci
 

PAYMENT OF CONFERENCE FEES MAY BE PAID ON LINE via CREDIT CARD or Pay Pal

Confirmation will be sent via email.
If you do not receive confirmation within 1 week please contact us at WEAAD@inpea.net

Thank you for your support...

Elder abuse should never be ignored!

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Because Elder Abuse should never be ignored!