Formulario

1. E-mail address : *

2. Full name: *

3. Country: *

4. Gender: *

Woman
Man
LGBTTQQIAAP
I'd rather not say

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

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

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

Spanish
English
French
Other. Please specify

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

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)

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

15. Field of the organization that you represent:

Local
Regional
National
International

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