Group Registration Form

Group Registration Form

Pre-Conference Registration will close on July 2nd, 2015. There will be an additional fee of $15US at the Conference site for all late registrations.

Participant registration includes full conference package and materials, all refreshment breaks including coffee breaks, entrance to receptions in the programme and ceremony for Award of Social Work Educators 2015. Participant registration also includes entry to exhibits, lectures, papers, workshops and scheduled field visits.

All workshop presenters, paper presenters, co-presenters and organisers are required to register for the conference and must be current 2015 ACSWE members.

Print and keep a copy of this document for your records.

Name of organization

Name of group contact person

Title First Name Last Name

Telephone Number of contact person Email address of contact person

( ) -

Method of payment (underline the selected option)

○ PayPal Invoice ○ Wire Transfer

Sample Registration Form

Fill out the form below for each individual in the group. Enter the relevant information in the lines provided below or underline the appropriate response provided.

Full Name

Dr. Jane Doe

Title First Name Last Name

Email Address * Phone Number

( 123 ) 456 - 7890

Address

12 Sample Ave Apt #7 Sample Ville Homes

Street Address Apt, Suite, Bldg. (optional)

Sample Town Sample Province

City/Town State / Province / Region

ST123 Homeland

Zip / Postal Code Country

Are you a presenter?

○ Yes ○ No Presenter Reference # (if yes) [ 77 ]

Fees

Please select the category which applies to you. Registration will be verified on-site.

o  Faculty of universities within the Caribbean region - US$300

o  Faculty of universities outside of the Caribbean region - US$350

o  Caribbean SW practitioners, agency staff, other Caribbean residents - US$150

o  Students (with valid picture ID) - US$50

o  Retired social workers & social work educators (aged 60+) - US$50

o  Other - US$200

PLEASE NOTE:

Residents of Grenada are asked to register on-site.

Persons who register by May31st, 2015 will receive the Early Bird discount of 15% off the applicable fee. Early Bird discount does not apply to Group Registrations.

Registration Form

Fill out the form below for each individual in the group. Enter the relevant information in the lines provided below or underline the appropriate response provided.

Full Name

Title First Name Last Name

Email Address * Phone Number

( ) -

Address

Street Address Apt, Suite, Bldg. (optional)

City/Town State / Province / Region

Zip / Postal Code Country

Are you a presenter? (underline the selected option)

○ Yes ○ No Presenter Reference # (if yes) [ ]

Fees

Please underline the category which applies to you. Registration will be verified on-site.

o  Faculty of universities within the Caribbean region - US$300

o  Faculty of universities outside of the Caribbean region - US$350

o  Caribbean SW practitioners, agency staff, other Caribbean residents - US$150

o  Students (with valid picture ID) - US$50

o  Retired social workers & social work educators (aged 60+) - US$50

o  Other - US$200

PLEASE NOTE:

Residents of Grenada are asked to register on-site.

Persons who register by May31st, 2015 will receive the Early Bird discount of 15% off the applicable fee. Early Bird discount does not apply to Group Registrations.

Registration Form

Fill out the form below for each individual in the group. Enter the relevant information in the lines provided below or underline the appropriate response provided.

Full Name

Title First Name Last Name

Email Address * Phone Number

( ) -

Address

Street Address Apt, Suite, Bldg. (optional)

City/Town State / Province / Region

Zip / Postal Code Country

Are you a presenter? (underline the selected option)

○ Yes ○ No Presenter Reference # (if yes) [ ]

Fees

Please underline the category which applies to you. Registration will be verified on-site.

o  Faculty of universities within the Caribbean region - US$300

o  Faculty of universities outside of the Caribbean region - US$350

o  Caribbean SW practitioners, agency staff, other Caribbean residents - US$150

o  Students (with valid picture ID) - US$50

o  Retired social workers & social work educators (aged 60+) - US$50

o  Other - US$200

PLEASE NOTE:

Residents of Grenada are asked to register on-site.

Persons who register by May31st, 2015 will receive the Early Bird discount of 15% off the applicable fee. Early Bird discount does not apply to Group Registrations.

Registration Form

Fill out the form below for each individual in the group. Enter the relevant information in the lines provided below or underline the appropriate response provided.

Full Name

Title First Name Last Name

Email Address * Phone Number

( ) -

Address

Street Address Apt, Suite, Bldg. (optional)

City/Town State / Province / Region

Zip / Postal Code Country

Are you a presenter? (underline the selected option)

○ Yes ○ No Presenter Reference # (if yes) [ ]

Fees

Please underline the category which applies to you. Registration will be verified on-site.

o  Faculty of universities within the Caribbean region - US$300

o  Faculty of universities outside of the Caribbean region - US$350

o  Caribbean SW practitioners, agency staff, other Caribbean residents - US$150

o  Students (with valid picture ID) - US$50

o  Retired social workers & social work educators (aged 60+) - US$50

o  Other - US$200

PLEASE NOTE:

Residents of Grenada are asked to register on-site.

Persons who register by May31st, 2015 will receive the Early Bird discount of 15% off the applicable fee. Early Bird discount does not apply to Group Registrations.

Registration Form

Fill out the form below for each individual in the group. Enter the relevant information in the lines provided below or underline the appropriate response provided.

Full Name

Title First Name Last Name

Email Address * Phone Number

( ) -

Address

Street Address Apt, Suite, Bldg. (optional)

City/Town State / Province / Region

Zip / Postal Code Country

Are you a presenter? (underline the selected option)

○ Yes ○ No Presenter Reference # (if yes) [ ]

Fees

Please underline the category which applies to you. Registration will be verified on-site.

o  Faculty of universities within the Caribbean region - US$300

o  Faculty of universities outside of the Caribbean region - US$350

o  Caribbean SW practitioners, agency staff, other Caribbean residents - US$150

o  Students (with valid picture ID) - US$50

o  Retired social workers & social work educators (aged 60+) - US$50

o  Other - US$200

PLEASE NOTE:

Residents of Grenada are asked to register on-site.

Persons who register by May31st, 2015 will receive the Early Bird discount of 15% off the applicable fee. Early Bird discount does not apply to Group Registrations.

Registration Form

Fill out the form below for each individual in the group. Enter the relevant information in the lines provided below or underline the appropriate response provided.

Full Name

Title First Name Last Name

Email Address * Phone Number

( ) -

Address

Street Address Apt, Suite, Bldg. (optional)

City/Town State / Province / Region

Zip / Postal Code Country

Are you a presenter? (underline the selected option)

○ Yes ○ No Presenter Reference # (if yes) [ ]

Fees

Please underline the category which applies to you. Registration will be verified on-site.

o  Faculty of universities within the Caribbean region - US$300

o  Faculty of universities outside of the Caribbean region - US$350

o  Caribbean SW practitioners, agency staff, other Caribbean residents - US$150

o  Students (with valid picture ID) - US$50

o  Retired social workers & social work educators (aged 60+) - US$50

o  Other - US$200

PLEASE NOTE:

Residents of Grenada are asked to register on-site.

Persons who register by May31st, 2015 will receive the Early Bird discount of 15% off the applicable fee. Early Bird discount does not apply to Group Registrations.