Consultation Dates: March 18 - 22, 2013 CCW Registration Form

Counseling in Chinese World 2013

Registration Form

Personal Information

Please Send to Email:

Family Name: Given Name: Gender Male Female

n  Spouse (if registering):

n  E-mail Address:
(Conference hotel information will be sent to this address. A secure e-mail is highly recommended)

n  Phone: Mobile: Fax:

n  Address:

n  Background and affiliation: Please include organization, title/position, and work description

Include me in the published participants list. On my name tag, put

Do not publish my name. On my name tag, put

I attended previous CCW 2010 (TW) 2011(TH) 2012(HK) Even Earlier

I am interested in leading an interactive workshop in the following topic relating to member care or counseling:

Housing

Standard accommodation is double room. Single rooms are available for an additional US$120

I have a roommate preference (roommate's name)

I want a single room

I want to commute from Chiang Mai. Local phone/mobile:

Payment

The registration fee includes 4 nights (March 18-22) singled or shared accommodation in a twin room, 4 breakfasts, 3 lunches, 4 dinners, and coffee breaks. Commuter package includes lunches, dinners and coffee breaks. We are unable to provide partial rates.

In order to guarantee your accommodation, we require payment at the time of registration. Please make check in US dollar (drawn from US banks, no bank drafts please) payable to: Glory Foundation and send to c/o Rudolf Mak, P.O. Box 87392 ToKwaWan Post Office, Kowloon Hong Kong. If you prefer to pay in other currencies (like RMB, Taiwan or Hong Kong dollar), please e-mail for details.

I will pay for the registration in: US dollar Other currency

US $550 per person (single occupancy) – conference package

US $430 per person (double occupancy) – conference package

US $270 per person (no accommodation and breakfast) – commuter package

US $50 late fee (applies after Jan 31 2013) per person

Consultation Dates: March 18 - 22, 2013 CCW Registration Form

Completed registration form can be sent by regular post to the above-mentioned Hong Kong address or e-mail to . If you are e-mailing your registration form in, please remember to send in your payment in order to avoid any delay in processing.

Scholarships

It is our goal that everyone invited be able to attend the consultation.

Please Send to Email:

I request a scholarship. [Please explain the amount you need and why.]

I will not be able to attend unless I receive a scholarship.

[If you check this, we will not process your registration unless we can provide a scholarship.]

I am enclosing a donation of $ to help others attend the consultation.

Arrival / Departure & Questions

The consultation will be held in Chiang Mai served by Chiang Mai International Airport (CNX). Full directions will be sent together with confirmation of your registration. You can check-in at the conference hotel starting by 2-3 pm Monday, March 18th. The consultation begins with dinner at 6 pm, followed by the evening session at 7:30 pm. The consultation ends with breakfast on Friday March 22nd. You are free to leave CNX on Friday morning. For questions about registration, concerns about confidentiality, local tours or any other requests, please contact: .

Security Guidelines

  1. The contributions of all participants are of value; no single individual, or organization is put in the spotlight.
  2. We respect the validity of various approaches to service and do not discount or seek to discredit the work of others, especially for the purpose of promoting our own work.
  3. Desiring to be supportive of the whole, we refrain from debating the relative merits of working with “official” versus “unofficial” bodies.
  4. Out of respect for one another’s backgrounds and positions we seek to situate our discussions within that broad area of common ground which we share, and we neither promote nor condemn distinctive positions.
  5. Should one participant feel constrained to exhort another regarding a chosen approach or sphere of work, this should be done in a spirit of love and sharing and should be handled privately.
  6. All matters discussed are considered confidential and are not to be shared outside the meeting without prior permission. Nothing is for publication.
  7. News of upcoming or past consultations, including the names of participants, should not be shared outside the organizations represented at the consultation, nor should this information be communicated to any representative of a government or a mass organization.
  8. Participation is by invitation only and participants should recommend potential participants to the organizers.
  9. By virtue of their attendance at the meetings, participants agree to be held accountable by their peers for upholding these principles and thus ensuring the integrity of the consultative process.