REGISTRATION FORM (NB. The preferred method of registration is online at

Transcription

1 REGISTRATION FORM (NB. The preferred method of registration is online at Date: / / This form allows you to register to attend the 15 th International Congress of the World Federation of Occupational Therapists Please print in block letters and keep a photocopy for your record. One form per person please. Note that all prices quoted are in US dollars. By completing this registration form, you have read, understood and agree to both the cancellation policies and the privacy statement as stated on the form and on the website. Contact Details Mr / Ms / Mrs / Miss / Dr / Professor / Associate Professor /Other (please specify): 1 st Surname 2 nd Surname (if applicable) Given Name(s) Organisation Address Suburb/Town Position State/Province Country Zip/Postcode Bus Telephone Bus Fax Mobile Telephone Home Telephone (inc international code) Congress Registration ($US) Registration Type Early Bird Rate (by 10 February 2010) Standard Rate (after 10 February 2010) Membership number / ID HIGH INCOME COUNTRY - refer to the World Bank classification on congress website WFOT Member 1 US $595 US $695 Non Member US $795 US $895 Day Registration Tuesday Wednesday US $325 US $325 Thursday Friday Student 2 Registration US $395 US $395 LOW INCOME COUNTRY category B or C country - refer to the World Bank classification on congress website WFOT Member 1 US $365 US $465 Non Member US $485 US $585 Day Registration Tuesday Wednesday US $195 US $195 Thursday Friday Student 2 Registration US $250 US $250 Note: 1. To qualify for the Member Rate, you must be a member of your National Association (which in turn must be a Member Association of WFOT), or an Individual Member of WFOT. Your membership status will be verified with the relevant association. Please go to for details of which national associations are WFOT members. 2. Student registrations must show valid student ID for 2009 or 2010 when arriving to register at the Congress. Students include those studying as full time undergraduates. 3. To qualify for the low income rate, you must be from a category B or C country. To check, please visit the congress website at 4. To qualify for early bird registration, registration fees must be received by 13 January Registration fees are based on date of payment receipt, not the date of receipt of registration form.

2 Pre Congress Workshop ($US) Pre Congress Workshops will take place on Sunday 2 May and Monday 3 May If you would like to attend a a workshop, select the desired workshop by placing a tick in the appropriate box & then select the applicable fee. WP-SF2 WP-SF4 WP-SF5 WP-SF6 WP-SF8 215 WP-SH1 WP-SH2 WP-SH3 125 WP-MF1 WP-MF2 WP-MF4 WP-MF5 215 WP-MH1 WP-MH2 WP-MH4 WP-MH5 WP-MH6 WP-MH7 WP-MH8 WP-MH9 WP-MH10 WP-MH11 SUNDAY 2 MAY 2010 Full Day Workshops "Promoción de la Participación Ocupacional: Integración de la Teoría y Práctica del Modelo de Ocupación Humana" - C.G. de las Heras Taller sobre applicaciones clínicas de la clasificación internacional de funcionamiento, de la discapacidad y la salud en terapia ocupacional - Maria L. Bustingorri Play as therapy: play assessment and intervention - Karen Stagnitti The Perceive, Recall, Plan & Perform System of Task Analysis: A method to identify the impact of cognitive strategy application errors on the performance of everyday tasks and routines in real-world contexts.- Judy Ranka Taller "Intervención Psicosocial Comunitaria en Promoción de Salud. - Mónica Palacios Tolvett, Paola Méndez Half Day Workshops Therapeutic Storytelling as an occupational tool that enables recovery - Jenny Stembridge de Aguilera, Lucho Aguilera Araneda Occupational Therapy, Ergonomics and Occupational Health -Thaís Tosetto, Angela Paula Simonelli, Daniela da Silva Rodrigues, Elaine Cristina Silva Compassion Fatigue - do we recognise it in ourselves? - Vivyan Alers MONDAY 3 MAY 2010 Full Day Workshops Confección de Mobiliários Adaptados en PVC - tubos y conexiones- para Pacientes con Disfunciones Neuromotoras - Grace Claudia Gasparini, Sandra Regina Barnabé Ramalho Zoratti Reconstruction of Paradise Lost: Addressing occupational needs in sexuality and intimacy for people with a disability and long-term illness - Matthew Yau ICF - International Classification of Functioning, Disability and Health - Introduction and perspectives for Occupational Therapy - Tota Dahl, Anne Carswell, Lena Haglund, Kerri Morgan, Tanja Stamm Blending Occupation Based Pediatric Approaches: Putting the Pieces Together - Clare Giuffrida, Emma Blanche, Mary Hallway Half Day Workshops How to strengthen the role of Occupational Therapy in the academic and clinical system - a joint presentation from the Karolinska Institute and the Karolinska University Hospital - Monika Samuelsson, Anders Kottorp, Susanne Guidetti, Annika Öhman The Canadian Occupational Performance Measure: Basic workshop - Mary Ann McColl, Nancy Pollock Psychoanalytic Thinking in Occupational Therapy; occupational engagement as symbolic, relational and transformative - Lindsey Nicholls, Julie Cunningham-Piergrossi, Carolina de Sena-Gibertoni Ubuntourism & Innovative Approaches to Meeting Societies - Frank Kronenberg Creating an occupation and competence based, flexible and interchangeable curriculum in line with the contemporary health paradigm and the historical roots of occupational therapy. - Dominique Van de Velde, Patricia De Vriendt Orientation to the Updated and Revised Manual for the Allen Cognitive Level Screen, Version 5 - Catherine Earhart, Claudia Allen, Deane McCraith Using online technologies in occupational therapy practice: A participatory workshop for therapists. - Anita Hamilton El Modelo Rio (Kawa); The Power of Culturally Responsive Occupational Therapy - Michael Iwama Terminología de terapia ocupacional en español: punto de encuentro entre Europa y Latinoamérica - Miguel Brea Rivero Using the Cognitive Occupational Model to Guide Occupational Therapy Practice with Persons with Dementia - Patricia Schaber 55

3 For translation purposes for the pre congress workshop, please advise if you are: English speaking Spanish speaking Both Education Day Registration for the Education Day is now closed. If you would like to be put on the waitlist (no guarantee of entry), please the WFOT 2010 Congress Office at Registration Type Membership number / ID HIGH INCOME COUNTRY - refer to the World Bank classification on congress website WFOT Member 1 US $105 Non Member US $125 LOW INCOME COUNTRY category B or C country - refer to the World Bank classification on congress website WFOT Member 1 US $85 Non Member US $105 Note: To qualify for the Member Rate, you must be a member of your National Association (which in turn must be a Member Association of WFOT), or an Individual Member of WFOT. Your membership status will be verified with the relevant association. Please go to for details of which national associations are WFOT members. Dietary Requirements Please indicate special dietary requirements that are not catered for in standard buffet selections. Vegetarian Gluten Free Allergy to: Welcome Reception ($US) Please refer to the Social Programme section at for full details. Inclusive Social Function (Full registrations and Tuesday registrations only) The Welcome Reception is included in the cost of the Full Congress Registration fee, and the Tuesday Registration Fee. If you register for one day only (other than Tuesday), you will need to purchase a ticket if you want to attend. Tuesday 4 May: Espacio Riesco For catering purposes, please indicate if you are attending. I will be attending Yes No Additional Tickets for the Welcome Reception Please indicate if you would like to purchase tickets to have partners or guests attend. $20 Number of Tickets: Total Cost: Guests Names Dietary Requirements for Guest (Welcome Reception) Vegetarian Gluten Free Allergy to: Gala Dinner ($US) Please refer to the Social Programme section at for full details. Additional Social Function The following social function is not included in the cost of the Congress Registration fee. Please indicate if you would like to purchase tickets for yourself and partners/ guests to attend. Thursday 6 May: Restaurant "LOS BUENOS MUCHACHOS" $US38.00 Number of Tickets: Total Cost: Guests Names

4 Menu Choice Please note that no special dietary requirements will be catered for at this function, but please indicate your preferred menu choice for yourself and partner/guest. Beef Chicken Salmon Guest: Beef Chicken Salmon Donation to Grants Programme ($US) Please refer to the Grants Programme under Academic Programme section at for full details. For some congress delegates from countries with developing economies, the idea of attending the WFOT Congress may seem an impossible dream. We have received many requests for funding from OT s (and students) in these countries, some of whom are also speakers at the Congress and are struggling to obtain funding to attend. If you would like to contribute to the Delegate Grants Programme, please indicate the preferred amount below. Donation to Grants Programme Transport & Accommodation Please note that transport will be provided free of charge to all congress delegates. Bus stops will be located several locations (i.e. listed hotels), regardless of whether you have booked accommodation through OTSI or arranged your own. Please refer to the Accommodation, Transport and General Info pages at for full details. Will you be staying at one of the congress hotels listed on the website? Yes, (please indicate which one) No, I will make other accommodation arrangements Maybe, I haven t decided yet Do you require daily transport between the congress venue and the listed congress hotels? Yes No Payment Summary ($US) All payments must be made in US dollars only. Please transfer all sub totals from the sections above and check your calculations carefully. Congress Registration Pre Congress Workshop Education Day Welcome Reception Gala Dinner Donation to Grants Programme Method of Payment: Cheque (payable in $USD to WFOT) All amounts in this brochure are in US dollars. Please note we do not accept bank transfers. Credit card payments are only accepted via the online registration link. If you prefer to pay by credit card (Visa, Amex, Mastercard) please go to and click on Registration. Please write the name of the delegate on the check for reference.

5 Privacy Statement: WFOT Congress 2010 is committed to supporting delegate privacy. The Congress will collect and store the information you provide in this Registration Form for the purposes of enabling us to register your attendance at the Congress, to assist with administrative and planning purposes and for future planning and development of the Congress and other events, to facilitate your requirements in relation to the Congress and to allow the compilation and analysis of statistics relevant to the Congress. The information that you provide in the Registration form and information provided at any other time during the Congress, including without limitation any feedback obtained during the Congress, will be used by the Congress to offer, provide and continue to improve its Congresses and other services. The Congress may disclose some of the information that is collected in the Registration Form such as your name, organisation and its location and your address to Congress sponsors and exhibitors for marketing purposes. The Congress will not otherwise, without your consent, use or disclose your personal information for any purpose unless it would reasonably be expected that such purpose is related to the offer, provision and improvement of the Congress or where such purpose is permitted or required by law. Cancellation Statement All cancellations received in writing to the Congress Office by Friday 1st April 2010 will be accepted and all fees refunded less a 100 administrative fee and any bank charges incurred by the Congress for the processing of the refund. Cancellations received after this date cannot be accepted and will not be refunded, however transfer of your registration to another person is acceptable. The full name and details of the person that will replace you must be advised in writing to the Congress Office prior to the Congress. No refunds will be made for non-attendance at the Congress. Tick here if you do not consent to your details being provided to Congress Sponsors or Exhibitors How did you find out about the Congress? Colleague told me Direct notification Journal advertisement Newspaper advertisement Received information in the mail Website search Workplace notice board Please complete and return this form to: WFOT 2010 Congress: Congress Office - Think Business Events Address: Suite 6, 23 Hoddle Street, Richmond AUSTRALIA 3121 Elizabeth wfot2010@wfot.org Ph: Fax: Website: