Symposium Registration Form

Registration Form

Please complete one form per person.
Full Name*

First NameLast Name
Preferred name for name tags *
This is the name that will be on your name tag
E-mail*
Occupation or field of practice*
Title (optional)
Organizational affiliation, if applicable*
Independent, free-standing affiliations are welcome
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone number*

Country CodeArea CodePhone Number

If you have any dietary requirements, please enter them here:
If you require any accessibility accommodations, please specify here:
YesNo
YesNo

A hope/wish/expectation for the Symposium:
How did you hear about us?*
Anything else you wish for us to know.

Student/Early Career proof of status:

If you selected the Student/Early Career option above, please provide a copy of your degree, transcript, student identification card, or a letter signed by the program head on university letterhead.
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Choose one of the following options:*

CSW26 Symposium Early Bird Fee

A 15% discounted rate for those registering by December 31st. This includes access to the full 1.5-day program, Friday night’s reception, and two refreshment breaks on Saturday.

$235.00

CSW26 Symposium Standard Fee

The standard rate for the Symposium. This includes access to the full 1.5-day program, Friday night’s reception, and two refreshment breaks on Saturday.

$275.00

CSW26 Symposium Student/ Early Career

A discounted option for students and early career professionals (two years post-graduate). This includes access to the full 1.5-day program, Friday night’s reception, and two refreshment breaks on Saturday. Please upload proof of status below.

$100.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: