Group Registration Application Form

  • We are delighted to have you register as a group for IEPA's upcoming virtual conference IEPA 2021 Virtual. Please provide us with some information about you and your group. We will use this information to organise your group registration. Please provide all information in English.
  • This will NOT be visible to delegates and this person does not necessarily need to register. This person will be the administrative contact for the group and will communicate to group members about registration
  • Please provide an email address that the conference organisers can contact you on. This will NOT be visible to delegates
  • Please provide a phone number that the conference organisers can contact you on. This will NOT be visible to delegates.
  • Please enter the number of people you wish to register as part of this group
    Please enter a number greater than or equal to 20.
  • Price listed is in US$
    Price: $ 175.00
  • Total Amount Due is displayed in US$
    $ 0.00
  • Please upload a .csv, .xlsx or .xls file listing for all group members (i) first name and (ii) last name (iii) IEPA Membership number (iv) email address. Please include at least 20 names. The maximum file size allowed is 64mMB
    Drop files here or
    Accepted file types: csv, xlsx, xls.
  • Please provide Billing Address for Invoice
  • Please provide an email address that the conference organisers can contact regarding payment. This will NOT be visible to delegates
  • Please provide a phone number the conference organisers can contact regarding invoice and payment.
  • Data Controller: IEPA Early Intervention in Mental Health Association Personal Information: Information provided during your registration to this event is collected and processed under the basis of our legitimate interest to provide you with this educational service. Uses & Sharing: We use your information to process your registration and presentation application and to communicate with you about this event and related events. This scientific meeting is one of identified participants - no anonymous participation is possible. By participating in this event your name and country and/or organisation maybe visible to other attendees. We temporarily provide personal information to companies that perform services to us and require them to protect your information in the same way we do. Your Rights: You have the right to receive the information we hold about you, ask to correct it or, under certain circumstances, to delete it. You have the option to unsubscribe from e-mailings on every email you receive from us. If you reside in the EU, you have the right to lodge a complaint with a supervisory authority, in particular in the Member State of your habitual residence, place of work or place of infringement, if you feel that the processing of your personal data infringes the General Data Protection regulation (GDPR). Contact us Any inquiries regarding data protection can be directed to our office at iepa2021@iepaconference.org
  • Please let us know if there is anything else we need to know about your group, organisation or payment methods.
  • This field is for validation purposes and should be left unchanged.