2019 10th GAJE Worldwide Conference & Training of Trainers Registration 2019 10th GAJE WORLDWIDE CONFERENCE LATE REGISTRATION FORM 1 General Information2 Conference Fees3 Presenter/Session4 Payment5 Passport Personal Information Page Upload*Please note : To help insure the security of the conference delates, the Pasundan University Security Team, our local hosts have asked we provide the passport information for each of the registered delegates. If you are from Indonesia, please add a scan of your national ID. Before starting your registration process, please upload a scan or photo of the personal information page in your passport. If you require more information regarding this, please email [email protected]Accepted file types: jpg, gif, png, pdf, jpeg.Family Name*NOTE: Please enter here the name that will be used to alphabetize lists of delegates (in most cases “last name” or “surname”).Given Name(s)*NOTE: Please enter here other name or names that, together with your “Family Name” entered above, will be use on the formal list of delegates (in most cases “first” or “personal” name or names).Short Name*NOTE: This should be the name that you wish other delegates to use when addressing you in person (in most cases your “first’ or “family” name, or it could be a “nickname”). Gender*Organization or Affiliation*NOTE: Please enter here the name of the primary organization or institution where you are engaged in justice education activity (university, legal clinic, NGO).Professional Title or Position*NOTE: Enter here your title or position with the organization or institution entered above (professor, director, advocate, researcher, etc.).Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweEmail*NOTE: This email address will be used for all communication regarding the conference, so please enter the address that you use most regularly. NOTE ALSO: You may enter only one email address. This is because your email address will also serve as your identifier for conference management purposes. Enter Email Confirm Email Do you want to use an approved WAIVER CODE?*If you have applied and received approval for a fee reduction or fee waiver, please answer "YES" and then you will be asked to enter your WAIVER CODE here. If you would like to apply for a fee reduction or a fee waiver please go to https://www.gaje.org/2019_conference_home/2019-fee-waiver-and-travel-grants/NoYesRegular Registration Fee*Regular registration fees for the conference are $350 USD for the Regular Conference, $425 USD for both the General Conference and the Training-of-Trainers (TOT) workshop. These fees are available between 8 Apr - 15 Sep 2019.Will attend only General Conference (4 - 8 Dec 2019) - USD $350Will attend the full conference, including Training-of-Trainers Workshop (4 - 10 Dec 2019) - USD $425Late Registration Fee*Late registration fees for the conference are $425 USD for the General Conference, $500 USD for both the General Conference and the Training-of-Trainers (TOT) workshop. These fees are available between 16 Sep - 1 Nov 2019.Will attend only General Conference (4 - 8 Dec 2019) - USD $425Will attend the full conference, including Training-of-Trainers Workshop (4 - 10 Dec 2019) - USD $500Fee Reduction or Full Fee Waiver NOTE: Please complete this section ONLY if you have received your WAIVER CODE and have been approved to pay a lesser amount by the Waivers and Grants Committee.WAIVER CODE*Please enter your approved WAIVER CODEFee Reduction Section*Please indicate if you are attending the General Conference or the General Conference and the Training-of-Trainers (TOT) workshop. Will attend only General Conference (4 - 8 Dec 2019) - USD $175.00Will attend the full conference, including Training-of-Trainers Workshop (4 - 10 Dec 2019) - USD $212.50Fee Waiver Section*Please indicate if you are attending the General Conference or the General Conference and the Training-of-Trainers (TOT) workshop. Will attend only General Conference (4 - 8 Dec 2019)Will attend the full conference, including Training-of-Trainers Workshop (4 - 10 Dec 2019)Training-of-Trainers Workshop NOTE: The Train the Trainers “TOT” will be held on December 9-10, 2019. The TOT is designed to provide an opportunity for teachers to enhance their skills and to be exposed to a range of teaching methods and tools. This year, the TOT will have two tracks. Participants must select one at the time of registration, either: 1) Implementing Justice Education in Diverse Contexts, or 2) Street Law. Advance registration is required, and registration is limited. Participation is on a first-come, first served basis. Because registration is limited, participants who register are required to attend on both days.Please indicate which TOT track you wish to attend:*Participants may only select one track. Implementing Justice Education in Diverse ContextsStreet Law Are you among the presenters in a session proposal that has been submitted (or will be submitted) for this conference?*NoYesTitle of Session*Lead Presenter for the Session*NOTE: If you are the Lead Presenter, please enter your name again Please list any health or diet-related needs.Volunteer Option*Please select if you would like to volunteer to help on some of the tasks during the conference and/or TOT YES - Volunteer at the General Conference OnlyYES - Volunteer at the General Conference & TOTNODonation to Support Others to Attend*We encourage you to make a donation and help to support others to enable participation of justice educators who are unable to find funding to attend and every effort will be made to use these funds to realize and advance GAJE’s mission. Donation of USD $25Donation of USD $50Donation of USD $100No DonationAuthorization to include name and contact information on List of Delegates*I agree to include my name and contact information on a published List of Delegates (applicable only for delegates who actually attend the conference)I do not agree to include my name and contact information on a published List of DelegatesPayment Options*Please select the appropriate payment option below and click on the “Submit” button that follows to submit this form. BUT NOTE: Your registration is not confirmed by submitting this form. When you submit this form you will be directed to a page that explains when and how your registration can be confirmed. NOTE ALSO: Payment with a PayPal account or a credit card is the preferred method for payment (payments made with a PayPal account is free for GAJE; with a credit card payment GAJE incurs a small transaction fee); Payment by check must be in US dollars; Payment by wire transfer or ETF may include substantial fees. PayPal or Credit Card – Will pay nowCheque – Will pay nowWire Transfer or EFT – Will pay nowSponsor Organisation to Pay - Request InvoiceI have been granted a full waiver by GAJE This iframe contains the logic required to handle Ajax powered Gravity Forms.