Proclaim 2021 Global Webinar       Registration Form
Date:
June 10 - 12, 2021, a free online hosted on Zoom



<Notice>
R-Center will send event t-shirts and lecture notes. You will need your home address to receive it,
so if you have already registered, please revisit and submit the Registration Form as soon as
possible.

For more information, please contact us at proclaim.global@gmail.com
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Email *
First Name *
Last Name *
Home Address (to receive event t-shirts and study forms, etc) (optional)
Do you have a preferred name to be called by, other than your first name? If so, please state here:
Gender *
Required
Age group *
Nationality *
Preferred language *
Previous attended year(s) of Proclaim *
2016
2017
2018
None
Check any/all that apply
T-shirt size(will be sent for the event.): *
XS(85)
S(90)
M(95)
L(100)
XL(105)
XXL(110)
XXXL(115)
Check any/all that apply
Please share any food allergies/restrictions that you may have.                                                                                    (***Zoom participants are not required to answer this question, just write Zoom.)
Please share any medical needs that you may have. (***Zoom participants are not required to answer this question, just write Zoom.)
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