NEUFELD INSTITUTE - Event Registration Form

Welcome! Once we have processed your payment, we will email you confirmation and orienting information. This normally takes from 1-2 business days.

• Identifying Details:

  Denotes Required Field

  Please provide us with the following information:
  First Name:		Last name:
  City:	Use the province/state and country selectors below for other information.	Email:
  Country:	Select Country Canada United States United Kingdom Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe	Province/State: (If required)	⇐ Select your country first

• Background Information

  Your response to the following questions would be greatly appreciated as your answers help in the processing of your purchase.
  If paying by Sponsoring Agency, please indicate name of Agency here, then contact our office with payment information (604-263-4278). Registrations are not processed without payment.

• Sessions

  You must pick one option from each the following sessions:            

  Pre-Conference Seminars

  Seminar 1: The Alarm Spectrum
  Presenter: Deborah MacNamara

  Seminar 2: Emotional Health in Our Schools
  Presenter: Hannah Beach and Tamara Strijack

  Seminar 3: Making Sense of Discipline
  Presenter: Genevieve Brabant

  Seminar 4: Play and Autism
  Presenter: Jule Epp

• Registration Options

  You must pick one of the following options:            

  The fee is

  CAD$

• Payment Options

  You must pick one of the following options:            

  Pay with credit or debit card through PayPal.
  Pay by Sponsoring Agency.

  Please make the cheque payable to 'Neufeld Institute', and send it to:
  

  Neufeld Institute,
  2155 West 36th Avenue,
  Vancouver, BC, Canada V6M 1L3

  Note that we cannot process your registration until the cheque is received and clears our bank.

  

  When you click the 'Register' button below, you will be directed to the site, where you can complete your payment. Note that you do not need an account with them to use a credit card for your payment to us. Click on the Don`t have a PayPal account? option once you get to the PayPal site.

• For security reasons, please enter the pink code into the box at the right:

  56d0f

Click here to Register for this Event

(Note that it can take a while for PayPal to respond - it can take as much as ten seconds, so please be patient.)