DUIM Toronto Registration If you are human, leave this field blank. TORONTO "ENGAGE DIFFERENCE! DUIM" PROGRAM REGISTRATIONTHIS OFFERING OF THE PROGRAM IS FULL Please fill out this registration form to be added to the wait list and to be informed of future offerings of the program. We will contact you if there are cancelations.Prior to registering please carefully read the program detailsWe are receiving a high volume of spam registrations from outside Canada. Unless pre-arranged through one of our partner organizations we will not accept registrations from outside Canada nor respond with a confirmation of registration. We are not able to provide funding for participation nor documents for immigration or visa purposes.Contact information: Name * Full name (first and last) Preferred name (For informal conversation, on name tags, etc.) Email * Address * Address Street address Street address Street address line 2 (optional) Street address line 2 (optional) City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands 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 Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor 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 Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania 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 Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Phone * Alternate phone If you have applied for a bursary from a Forum for Intercultural Leadership and Learning / Canadian Council of Churches 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): Sponsoring Agency or Institution 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 information: Gender Decade in which you were born Select decade 2000's 1990's 1980's 1970's 1960's 1950's 1940's 1930's 1920's Denominational or institutional affiliation Post-secondary education Special interests and/or talents DUIM Program related information:The DUIM 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 DUIM program page (www.interculturalleadership.ca/duim) for the program schedule. The course runs 9:00 am Monday to 5:00 pm evening on Friday.There will be evening activities several nights of the program. Commitment to attend * Yes, I can commit to attending the full programThis course offering has an option to be taken for course credit through Wycliffe College for a small additional cost. Please contact The Forum for Intercultural Leadership and Learning for more information. I am interested or plan to take receiving academic credit for this course Yes No I have already registered for this course through Wycliffe College Yes No 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 non-residential program. Past participants have recommended finding accommodation near the program as it provides an opportunity for informal time with other participants and to focus on the course learnings during the week. Those travelling from away from the program location will need to arrange accommodation.** If needed, it is your responsibility to arrange your own billet or accommodation. We will provide a list of suggested housing options.Special Dietary and Other Needs: Please describe any mobility or other ability issues: Vegetarian Entrées I prefer vegetarian entrées only Other dietary needs or food allergies (if any) Other, non-food related, allergies (if any) Notes on the registrationOnce you click "submit registration", there will be a message 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 it does not arrive in your inbox, please check your "junk mail" or "spam" folder. reCAPTCHA Submit Registration
