International Center for Law and Religion Studies | Islamic Perspectives on Human Dignity

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

Given Names(Required)

Surname(Required)

Gender(Required)

Birthdate(Required)

Preferred Name on Badge(Required)

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

Official Position(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)

If you are living in Doha, please enter Doha for Departure and Return city.

Return City (and Airport)(Required)

If you are living in Doha, please enter Doha for Departure and Return city.

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)

Guest travel and lodging costs are covered by the guest and not by the conference organizers.

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 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 (limit to 200 words)(Can cut and paste from another document)

Link: View 2023 Terms and Conditions

Islamic Perspectives on Human Dignity – Doha 2023 Conference Registration