Barrie "Engage Difference! DUIM" Program Registration

(Prior to registering please carefully read the program details at http://www.interculturalleadership.ca/duim)

Contact information:

Name (required)

Preferred name: How you prefer your name to be written on name tags, etc.

Email (required)

Address (required) -- please include full address including city, province, & postal code

Telephone (required)
Alternate phone

If you have applied for a bursary from a Canadian Council of Churches or Forum for Intercultural Leadership and Learning partner or your fees are being paid by a sponsoring agency they can be invoiced directly. Please indicate the agency or institution which will pay a portion or all of your fees (if applicable):
Shortly after you register we will be in touch with details for paying a deposit to confirm your registration and payment of balance of fees.

Personal:

Gender
Decade in which you were born

Denominational or institutional affiliation

Post-secondary education (if any)

Special interests and/or talents

Engage Difference! DUIM Program related information:

The program is designed so that sessions build on each other and are within a learning community.
It is important that you are present for the full program.
Please refer to the program page (www.InterculturalLeadership.ca/duim) for the program schedule.
Course runs 9:00 am Monday to 5:00 pm evening of Friday.
There will also be activities some evenings.
I can commit to attending the full program: YesNo

Please describe your ministry setting

If you have previous training or experience in intercultural ministry please very briefly name which have been the most significant for your learning.

What is your primary learning goal for this program?

Accommodation:

This is a residential program.

Accommodation and meals are also available prior to or after the program (at an additional cost) . Please contact Forum for Intercultural Leadership and Learning after registering.

I may need accommodation the night before or after the program YesNo

Special Dietary and Other Needs:

Please describe any mobility or other ability issues:

• I prefer vegetarian entrées only: YesNo
• Other dietary needs or food allergies (if any)
  
• Other (non-food related) allergies (if any)
  

There will be a message below to confirm successful submission of this form or you will be asked to resubmit with missed information.
An automated email will be sent to confirm that we have received your registration.
IF A CONFIRMATION EMAIL DOES NOT ARRIVE PLEASE CHECK YOUR JUNK/SPAM MAIL FOLDER. TO ENSURE YOU RECEIVE FUTURE CORRESPONDENCE MARK EMAIL FROM THE DOMAIN @COUNCILOFCHURCHES AS NOT JUNK/SPAM MAIL.