7th European & William Glasser International

Choice Theory & Reality Therapy Conference

EIRT Program Student Registration

 Mediterranean Breeze - The Wind of Change
Amadria Park, Sibenik, Croatia, 24th - 27th June 2020


 


  1. Please read all of the field titles carefully, and complete all fields and questions



  2. Your name (EIRT RTP Program Student)*
    We need your full Name
  3. House Number or Name
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  4. Street
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  5. Town/City*
    What city/town do you live in
  6. Post/Zip Code*
    What is your Post/Zip Code
  7. Country*
    What is your Country
  8. Cell/Mobile Number
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  9. Email Address*
    We need a valid email address for you
  10. Profession
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  11. Other profession if not listed
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  12. Area of Expertise
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  13. What level of CTRT training have you completed?





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  14. Faculty?




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  15. Special requirements - tell is if you have food allergies for example.

  16. Comments
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  17. If you have indicated that you have special dietary requirements, you should also advise the accommodation staff & caterers when you arrive (especially if you have allergies to certain foods)

  18. I am a registered EIRT Program Student*
    You must be a registered EIRT Program Student

  19. Payment Information:


    Amount due: EIRT Student Programme: €250.00


    Payment should be made by bank transfer (details will also be sent to you by acknowledgement email)

    All payments should be in Euros, and bank charges paid by you please.

    Use your name + country code as reference (for example Tanja Smith Cro)




  20. Privacy Notice (GDPR)


    I agree that my personal information add to this form can be collected, processed and publicly released for the conference purposes

    You can revoke this, at any time, by sending a written email request to the Conference organiser with a subject title: revoking personal data.


    Please note that your personal data is used for administration purposes during the conference.


  21. General Data Protection Regulations*
    This is required



  22. Tick the box to prevent SPAM*
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