Wufoo

Safety Institute Conference Registration SE Asia

This conference is for (M) women serving cross-culturally throughout the world. It is for women who speak English fluently. The nature and content of the conference is appropriate for married, single, widowed, and divorced women (18 years and above) but is not a setting for nursing infants or children. We are unable to accommodate additional family members during the conference as you will be sharing a room with another conference participant. We very specifically desire to place women in an environment that allows them to step back from the daily responsibilities of family and company and be encouraged by one another. Once you arrive at the conference location we will cover the cost of your lodging, meals, and conference material.

All conference participants must fill out this registration form to be officially registered. You will receive an e-mail confirmation for the conference when your registration has been received and processed. The location for the conference is SE Asia and the dates are September 21-24, 2016. Contact vickie@safetyinstitute.com for more information if needed.

Note: The conference is limited to 50 participants. Our policy is first come first serve. After 50 we go to a waiting list. Therefore if someone has to cancel for a medical, family, and or company emergency that spot can still be filled. We move women up the waiting list in the order they register.

Confirm that you have read the paragraphs above. *
I have read the paragraphs above and understand the requirements for the conference.
Last Name *
First Name *
Name as you prefer on your Conference Nametag *
Email Address *

Please use an email address that you check frequently.
Company *

Please tell us the name of the company you work.
Sending Country *

This is usually the country where you grew up.
Country of Service *

This is the country you are now working in for the company you specified above.
How did you hear about this conference *
Bio
Please give us a short (300 words or less) bio. Please include information about your work, family, and what you enjoy in your free time. This bio will be used by team members to get to know you and will be printed in a conference notebook that will be given only to those that attend. *
Maximum Allowed: 300 words. Currently Used: 0 words.
Snacks
We like to bring goodies with us to the conference. Tell us your favorite snack food and we will try to include it. *
Maximum Allowed: 200 words. Currently Used: 0 words.
Favorites
Please give us an idea of some things that you are unable to get or miss from home. They must fit in a gallon size ziplock bag. *
Maximum Allowed: 200 words. Currently Used: 0 words.
Roomate
If someone that is coming to the conference who you would enjoy as a roommate, please place her name here.
SKYPE
If you use Skype for communication and would like to share that with us please place that information below.
Permission
During our conferences we take photos and shoot video that may later be used on our web site or in printed material. Please indicate below your permission for us to use such media or let us know that you prefer not to have your image used. Your name tag issued at check-in will be marked according to your choice. *
I give permission to use my image. I DO NOT give permission to use my image.
Have you attended a previous conference with our organization? If yes, which one?

List the country and year that you attended.
Do Not Fill This Out