Fall Professional Development Program – Forms and Payment

Thank you for your interest in the Fall Professional Development Program. Please fill out the below registration to secure your place at the forum

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Professional Development Applicant Information Fall 2024

Name*

First Last

Professional Title

Email*

Gender / Pronouns*

Work Phone*

Cell Phone

Institution Information

Name of Institution*

Institution Address*

Website*

Trip Information

Please let us know if you are coming with other colleagues, or a partner, or a friend, or on your own. Accommodation is based on shared twin or double rooms- Private single accommodation is available and will incur an extra charge. There is an early bird rate available if you register & pay your deposit before July 1, 2024.

Accommodation Preference*

Dietary Requirements (Vegan/Vegetarian/Gluten-Free Etc.)*

Who is coming with you?

Let us know if you are travelling with a colleague, a partner or a friend? Please note that this is not a suitable program for children or teenagers.

Please clarify your arrival and departure dates below. If you need assistance booking an extra night before or after the dates, let us know.

Adding on some time to your trip? If you would like some assistance with booking in to your conference hotel a day early, or stay on a day later, we can assist you. Please note that the conference dates are from the day the program begins. So if conference dates say September 12-17 that means you should arrive in Ireland on September 12 and depart on September 17.

Payment Information

A deposit of $98 is required to confirm your place at the forum. Deposit receipts and payments may be invoiced and/or copied to institutional sponsors.

Deposit*

Price:

Total

Credit Card*

Card Details

Cardholder Name

Billing Address*

Street Address City County / State / Region ZIP / Postal Code Country

Name

First Last