First Annual Research Conference Registration
Register for Phronesis International College (PIC) First Annual Research Conference. Complete your personal details, professional background, participation type, attendance days, accessibility or dietary needs, payment details, communication preference and required declarations.
Personal Information
First Name
*
Last Name
*
Email Address
*
example@example.com
Phone Number / WhatsApp Number
*
ID / Passport Number
*
Gender
*
Please Select
Female
Male
Non-binary/Other
Prefer not to say
Town/City
*
Nationality
*
Professional Background
Profession / Occupation
*
Organisation / Institution
*
Department
*
Highest Qualification
*
Please Select
Certificate
Diploma
Degree
Honours
Masters
PhD
Other
Category
*
Please Select
Student
Counsellor
Researcher
Academic/Researcher
Practitioner/Professional
Other
Area of Interest
*
Please Select
Mental Health
Counselling
Education
Psychology
Social Work
Research
Healthcare
Community Development
Other
Attendance Details
Days Attending
*
Day 1 Only
Day 2 Only
Both Days
Attendance Type
*
Physical
Virtual
Need CPD Certificate?
YES
NO
Attendance note
Accessibility Requirements & Dietary Needs
Dietary Requirements
Please Select
None / No preference
Vegetarian
Vegan
Halal
Gluten-free
Halal
Diabetic
Food Allergies
Other
Accessibility Requirements or Special Needs
Payment Details
Payment Information
Payment Reference Used
Amount Paid
Date of Payment
-
Month
-
Day
Year
Date
How did you hear about this conference?
Please Select
Social Media
Colleague / Word of mouth
College Website
WhatsApp
Newspaper/Radio
Other
Communication Preferences
I confirm the information provided is accurate and complete.
Receive conference updates
Receive future PIC event invitations
Join research/community mailing list
Declarations
I confirm the information provided is accurate and complete.
*
I confirm
I agree to the conference code of conduct and ethical guidelines.
*
I agree
I consent to photography/video recording during the conference for institutional and promotional purposes.
*
I consent
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