International Center for Law and Religion Studies | 2024 Law and Religion Symposium Registration Form

Salutation (e.g., Mr., Ms., Mrs., Dr., Prof., Rev.)

Given Names(Required)

Surname or Family Name(Required)

Honorific

Gender(Required)

Birthdate(Required)

Preferred Name on Badge(Required)

Name as it should appear on the program(Required)

Job Title/Position(Required)

Organization Name(Required)

Address Line 1

Address Line 2

Address Line 3

City

State/Province

Postal Code

Country(Required)

Preferred Phone (include country and area code)(Required)

WhatsApp Number (include country and area code)(Required)

Preferred Email(Required)

Alternate Email

Primary Language(Required)

English Fluency(Required)

Assistant Name

Assistant Work Phone

Assistant Email Address

Full Name on Passport(Required)

Passport Number(Required)

Passport Issue Date

Passport Expiration Date

Passport Place of Issuance

Passport Issuer

Departure City (and Airport)(Required)

Return City (and Airport)(Required)

Preferred Airline

Preferred Seating

Frequent Flyer Number (if available)

Do you need assistance to process visa?(Required)

Please specify visa assistance needed

Dietary Restrictions

Other Special Needs

Accompanied by spouse/guest?

Spouse/Guest's Given Name(s) (if attending)

Spouse/Guest's Surname or Family Name (if attending)

Please note: Guest travel and additional hotel room costs are paid by the guest and not by the conference organizers.

Will the delegate be sharing a hotel room with their guest or does the guest need a separate hotel room?

I have emailed (or will email) a scanned copy of the picture page of my passport.

I have emailed (or will email) a high-resolution headshot of myself.

I am willing to receive further communications from the organizers (e.g., program information, flight arrangements, etc.)(Required)

Please write a brief biography in paragraph form (limit to 150 - 200 words)(Can cut and paste from another document)

Link: View 2024 Terms and Conditions

Consent(Required)

I agree to the above terms and conditions relating to the event.