International Center for Law and Religion Studies | 30th International Law and Religious Symposium

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

Given Names(Required)

Surname(Required)

Gender(Required)

Birthdate(Required)

Official Position(Required)

Preferred Name on Badge(Required)

Full name as it should appear on the program)(Required)

Organization/Institutional Affiliation(Required)

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country(Required)

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

Alternate Phone (include country and area code)

WhatsApp Number (include country and area code)

Preferred Email(Required)

Alternate Email

Do you need assistance to process visa?(Required)

Please specify visa assistance needed

Departure City (and Airport)(Required)

Return City (and Airport)(Required)

Preferred Airline

Preferred Seating

Frequent Flyer Number (if available)

Accompanied by spouse/guest?

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

Spouse/Guest's Surname (if attending)

Dietary Restrictions

Other Special Needs

Primary Language?

English Fluency(Required)

Full Name on Passport(Required)

Passport Number

Passport Issue Date

Passport Expiration Date

Passport Place of Issuance

Passport Issuer

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

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

Please write a brief biography (limit to 100 words)(Can cut and paste from another document)

Consent(Required)

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