Inaugural World Conference Registration Form
REGISTRANT INFORMATION
(Please print or type. Send one form for each registrant. You may photocopy this form if necessary.)
__________________________________________________________________ Last Name (Family Name) First Name Credentials (MD, PhD, MSW, etc.)
__________________________________________________________________ Organization Your Title
__________________________________________________________________ Street Address
__________________________________________________________________ City State Postal Code Country
__________________________________________________________________ Telephone Fax e-mail
I have the following special needs (e.g., vegetarian meals, wheelchair access, other):_____________________________________
REGISTRATION FEE
The registration fees (includes meals listed in agenda below) are:
Early-bird registration fee (received by July 1, 2000) $350
Regular registration fee (received after July 1, 2000) $400
Please submit registration form by September 15, 2000.
PAYMENT INFORMATION
- I enclose a check/money order in US dollars for $ ______________
made payable to World Federation for Mental Health - Please charge my credit card for $ __________________________
My credit card is: Visa Mastercard
Credit card number: ____________________________________________ Expiration date:_____________________________
Cardholder name: ____________________________________________________________ Cardholder signature:__________________________________Date:_______________ Cardholder address:______________________________________________________
REFUND INFORMATION
Up to August 31, 2000, 50% of the fee will be returned in the event of a cancellation. Up to October 31, 2000, 25% of the fee will be returned in the event of a cancellation. From November 1, 2000, no refunds will be made, but a substitute will be able to attend for an administration fee of US$40.
GENERAL INFORMATION
- You are responsible for HOTEL and TRAVEL arrangements. After receipt of this registration form, a confirmation letter will be sent to you with hotel and travel information. A.-ange of hotels and prices have been reserved for conference participants.
- In order to prepare a final program for distribution, al,’presenters are required to register for the conference byjuly 1, 2000, and pay the registration fee.
- If you are interested in receiving information about potentially available scholarships, please contact the World Federation for Mental Health by mail, fax US 703-519-7648 or e-mail
. - Due to space constraints, we are unable to accommodate spouses or guests at any functions held at The Carter Center.
- Please forward registration form and proper payment (in US dollars) to Inaugural World Conference, World Federation for Mental Health, 1021 Prince Street, Alexandria, VA 22314, USA, or send by fax US 703-519-7648 with credit card information or email to [email protected]
- If you have further questions, please contact WFMH by mail, fax, or e-mail. No telephone calls please.
SCHEDULE AT A GLANCE
Tuesday, December 5
3:00 p.m. – 6:00 p.m. Registration (at hotel to be announced)
6:30 p.m. – 8:30 p.m. Welcome reception (at hotel to be announced)
Wednesday, December 6
9:00 a.m. – 6:00 p.m. Plenary/symposium sessions at The Carter Center (lunch included in registration)
7:30 p.m. – 9:30 p.m. Buffet reception at The Carter Center (included in registration)
Thursday, December 7
9:00 a.m. – 6:00 p.m. Plenary/symposium sessions at The Carter Center (lunch included in registration)
Time to be determined Evening buffet reception at location to be determined, or evening on your own
Friday, December 8
9:00 a.m. – 4:00 p.m. Plenary/symposium sessions and adjournment at The Carter Center (lunch included in registration)
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