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2024 Portugal ITW Registration Form
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* Indicates required question
Your preferred e-mail address for ITW correspondence
*
Your answer
May we include your e-mail address on the ITW list to be shared with other participants?
*
Yes
No
Your name and professional credentials (MA, Ph.D., MD, LCSW, LPC, RPT, IAAP, etc.),
exactly as you would like them to appear
on the participant list and certificates for training and supervision.
*
Your answer
For your name tag; your first name, last name, and country of residence.
*
Your answer
Your nationality
*
Your answer
Your current city, state or province, and country of residence
*
Your answer
Your mobile phone number, including country code, where we may reach you by phone call or text when in Portugal.
*
Your answer
I am interested in registering for the:
*
Week One ITW, to be held from November 4th to 10th, 2024
Please place me on the Waiting List for Week Two to be held November 18th to 24th, 2024
Previous ITW attendance
*
I have never attended an ITW
I have previously attended one ITW
I have previously attended two or more ITWs
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