International Permaculture Conference & Convergence

IPC9 Pre-Registration Form

Everyone planning to attend any IPC9 event is required to pre-register online using the form below. Please fill out all required information, indicate that you accept the terms and conditions, and click SUBMIT.

Your Name*:              (*required)

Title (Prof/Dr/Mr/Mrs/Miss/Ms):

Mailing Address*:

Physical Address (if different than mailing address):

Home Phone*:

Work Phone:

Cell Phone:

FAX:

Email Address*:

Website:

Age*:

Gender*: Female   Male

Native Language*:

Secondary Language(s):

Special dietary requirements:

Special mobility and/or sensory needs:

PLANNING TO ATTEND (check one or more):

International PDC Course, Harare, Zimbabwe, 18-29 Oct., 2009
IPC9 Convergence, Lilongwe, Malawi, 2-5 Nov., 2009
IPC9 Conference, Lilongwe, Malawi, 6 Nov., 2009
Permaculture Site Tours in one country only, 7-16 Nov., 2009
Permaculture Site Tours in Malawi, Zimbabwe, and South Africa, 7-30 Nov., 2009

PRESENTING AT THE CONFERENCE AND CONVERGENCE

Do you wish to make a presentation at the Convergence or Conference?Yes No

Title of your presentation:

Format of presentation:

Approximately how much time will you require?

Please give a short abstract of your presentation (400 words max.):

What equipment will you need from the organisers?

Are you bringing posters and other materials to display? Yes No

ORGANIZATION DETAILS (if applicable)
If you are a member of a permaculture organization or other group

Name of organization:

Country of the organization:

Your position in the organization:

Contact Name:

Contact Email address:

Contact Tel:

Website:

SPONSOR DETAILS (if applicable)
Sponsor for your participation at IPC9

Name of sponsor organization:

Contact Name:

Contact Email address:

Contact Tel:

DETAILS OF PERMACULTURE TRAINING*
(PDC = "Permaculture Design Certificate Course")

Have you completed a PDC*?Yes No
(Answer "Yes" if you will complete a PDC before Nov. 1, 2009)

Name of your PDC Teacher*:

Date of PDC Completion (MM/DD/YYYY)*:

Location of PDC*:

Summary of experience in permaculture (if any):

TERMS AND CONDITIONS*

Health and Safety: I will take all reasonable precautions to ensure my health and safety throughout my participation at the IPC9 event(s) and that I will be responsible for my own health care and insurance. I will further take responsibility to learn about the health and safety conditions in the areas to be visited.

I pledge to show respect for other cultures and for divergence of views throughout all IPC9 events and tours.

I hereby accept to register for the event(s) under the terms and conditions above: *
YES NO

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