Formulario

1. E-mail address : *

2. Full name: *

3. Country: *

4. Gender: *

5. Age *

Under 18 years of age
From 18 to 30 years old
From 31 to 50 years old
51 to 65 years old
Over 65 years of age
None

6. Education level: *

7. Telephone contact number:

Area code: telephone number:

8. How did you learn about the 19th IOPD Conference? *

19th IOPD Conference website
IODP website
Iztapalapa Mayor's Office Website
Social Networks (Facebook, Twitter, others)
E-mail
Word of mouth
Other. Please specify
None

9. What is your mother language? (Select the corresponding option) *

10. Requires simultaneous translation service (Select all corresponding options) *

Spanish-English
Spanish-French
English-Spanish
English-French
French-Spanish
French-English
None
None

11. Type of participation: *

On your own
Representative of an entity or organization (if this option was indicated, please also answer questions 12 to 16)
None

12. Organization that you represent:

13. Your position

14. Type of organization that you represent:

Government
Organizations and social movements
Civil and professional organizations (NGOs)
Academy/Research
International organizations
Municipal networks
Others
None

15. Field of the organization that you represent:

16. Describe its activities (100 words maximum)

17. Date of your arrival at Iztapalapa, CDMX:

18. Date of your departure from Iztapalapa, CDMX:

19. Where will you stay during the conference? (Place name and address)

20. Do you have any dietary restrictions?

No
Yes, which one?

21. Do you have any questions, comments or suggestions? We want to hear from you!

REGISTRATION FORM