REENTRY CONFERENCE REGISTRATION Contact and Sponsor information: Name (required) Name you prefer to be called by (if different than above) Email (required) Address (required) Telephone (required) Cell phone Name of sponsoring agency (required) Program fees should be billed to SponsorParticipant Personal and Family information: Gender Decade in which you were born Post-secondary education Special interests and/or talents Spouse's name (if applicable)* *If your spouse is also going to participate in this Forum program, he/she must submit a separate registration form. Did your spouse accompany you on your placement? YesNo Names and ages of children who accompanied you on your placement (if any) Re-Entry-related information: List the countries in which you have served with dates of service (Please press Enter after each country entry): Were you in areas where violence was present? YesNo If Yes, please describe your experiences: (to help us adapt the reentry program to the participants' experiences) Date of arrival back in Canada (or the United States) Are you presently in paid employment? YesNo If Yes, please describe: Are you currently looking for paid employment? YesNo Are you currently in full-time studies? YesNo Please describe any future plans: Travel information: How are you travelling to the Re-Entry Program (if known*)? *If you have not made travel arrangements yet, please notify the Forum as soon as you have arrival and departure information. Arrival date and time Departure date and time Accommodation and Special Needs: Accommodation will be a single room unless otherwise indicated. Do you prefer a double room with your spouse or partner also participating in the conference? YesNo Name of person sharing room with you: 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) Once you click "submit registration" watch below for a confirmation. 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.