ICCM Europe - EU2009 - Registration

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ONLINE CONFERENCE REGISTRATION

International Conference on Computing and Missions
February 4 (Wednesday) - February 7 (Saturday), 2009
- De Betteld - The Netherlands -

- PLEASE FILL OUT THIS FORM AND SUBMIT AT THE END -

Personal details

Our promise:	We will NOT publish or share any of the personal information entered below
	without asking your permission. All details are for ICCM internal use only
	EXCEPT for the three instances explained in blue below
First Name:
Last Name:
Nickname:
Date of Birth:	Month: Day: Year:
Have you ever visited an ICCM Conference elsewhere?:	NO YES, my last ICCM was in:
	How did you hear about ICCM-Europe?:
	(From a website / ICCM USA / Friend / Leaflet / etc)

Gender:	Male Female
Organization:
Organization website:
Is your organization a:	Mission Church Business Non-profit
	Other, please specify
Your email address:
Street Address:
Town/City:
Province/County/State:
Postcode/Zip:
Country:
Address privacy exception 1:	We produce a list of conference attendees for use during and after the conference.
	This list will be printed and added to your welcome pack.
	Can we include your full name, organization and email address on this list?
	As well as print a personal name tag with your name and organization?
	NO YES, you can use this information as described above.
Telephone:
I would like to share accommodation with:
	(Note: We can't guarantee that you will be able to share with them, but we will do our best.)
	We intend to help you get to the conference by running a shuttle service from Doetinchem train station.
	More details can be found on the Travel Information page
How will you be traveling to the conference?:	Car \| Air \| Train \| Other
Travel details:
Address privacy exception 2:	We would like to inform attendees that live in the same country about others traveling to ICCM
	Can we share your full name and email address to persons that live close to you?
	Even before the conference starts.
	NO YES, you can use this information as described above.
	IN CASE OF EMERGENCY:
Contact Name:
Full international contact phone number:
Contact Country:
	If you bring your spouse please double the conference price
	Unfortunately, this year we cannot provide accommodation for children
Spouse first name:
Spouse last name:
Spouse date of birth:	Month: Day: Year:
	Special Needs, please explain: (Special diet required,
	allergies, difficulty with steps, snoring, light sleeper, etc.)

	Other Comments or Information that will help us making your time at ICCM the best it can be:

	If you have further questions please email: registration(AT)iccm-europe.org

	If you would like to receive a copy of the details you have
	submitted here, please enter your email address again:
Your email address:
	We will try and confirm your registration manually within a few days

PLEASE ASK COLLEAGUES AND FRIENDS TO REGISTER AS EARLY AS POSSIBLE
This will help the ICCM Europe preparation team to plan enough workshops for everyone!

Can you help shape the conference?

Please help us shape this conference based on your preferences

We are organizing the tracks for the conference with leadership, web technology and general technology themes.

This will only cover a small part of the technology industry and how it can be used in mission. Time is given within

the programme for Birds of a Feather (as in "flock together") or BOF sessions. These allow us to have structured

time for as yet undefined topics depending on the needs of the attendees. By completing information in this

section, we can define some of these areas before the conference and get a better idea of what would be helpful

to you as attendees.

The following questions are best answered by giving keywords.

Use as many keywords as you like

- Privacy exception 3: -

Depending on the answers we get during registration

we might add some keywords to your name on the attendee list.

This will allow people to identify persons with experence in certain areas.