Music &….Mental Health An Inclusive Interdisciplinary Conference Saturday 13th April 2019 – Sunday 14th April 2019 Bruges, Belgium ****** Bruges - Music &….Mental Health Conference Registration Form 2019 Event registration for Music &….Mental Health Conference, April 2019, Bruges, Belgium is now open. You will need to complete this registration form. Please be aware that registration for this event is only open for people who submitted and have now received written confirmation of their acceptance of a presentation or some form of participation. Your Details Information provided on this form will be securely stored by Progressive Connexions and used solely for the purposes of communications relating to this conference. Name* First Last Affiliation/AssociationAddress Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Enter Email Confirm Email Your name, affiliation/association and email address will appear in the printed Book of Abstracts which will be available in delegate packs at the conference. Please check this box if you do NOT wish this information to appear. I do not wish my name, affiliation or email address to appear in the Book of Abstracts Your ParticipationType of Participation*PresentationSession ChairConduct WorkshopAvailable to Sit on Q&A PanelEnd of Day SummariserPerformancePoster PresentationParticipate in some other MannerEveryone who attends must actively participate in this event.Title of Participation*Enter the brief title for your presentation.Co-PresentersPlease list any co-presenters, panel participants and other persons who will also be a part of the presentation.Confirmation of Participation* I confirm I have received written confirmation of participation . Special RequirementsSpecial NeedsAs part of our ethos of inclusiveness, we are committed to doing our best to try and support participants who may have special needs. Please advise us of any disability or condition that will affect your participation at the event so that we can discuss the necessary arrangements (where possible).Food RequirementsPlease advise us of any special requirements or food allergies. Please note: it is not always possible to arrange for food to be prepared in accordance with strict religious requirements. Where it is possible, there are often additional costs associated with its availability. Payment Options3>Payment Methods*The following list outlines the payment methods we are able to accept. Your invoice will prepared using the method you select. The conference registration fee is £295. Accommodation costs are additional. Please Note: all fees must be paid prior to arrival at the conference. Participants with unsettled invoices will not be granted access to the event. Cheque (GBP only). All cheques to made payable to: "Progressive Connexions". Cheques must be drawn against a bank with headquarters in the UK. Bank Transfer (full details provided on invoice) Credit Card PayPal; please specify the e-mail address to which request for payment is to be made. Invoice Terms and ConditionsBefore proceeding any further, please carefully read this cancellation notice. By signing this form you consent to accepting the cancellation policy and agree to be bound by its terms and conditions. The policy will be rigorously enforced. ~ Cancellation 60 days before the start of the conference = no penalty ~ Cancellation within 60-30 days before the start of the conference = 35% of total costs ~ Cancellation within 29-14 days before the start of the conference = 75% of total costs ~ Cancellation within 14 days (including no shows) before the start of the conference = 100% of total costs Please note: Any refunds to non-UK bank accounts will be liable to a 17GBP handling fee. Progressive Connexions retains the right to alter or cancel this conference and will provide notice as quickly as practicable of any cancellation or material alteration. Neither Progressive Connexions nor its agents or employees will be required to reimburse travel or other costs incurred by participants because of cancellations or alterations of the event. Refunds for cancellations are subject to the cancellation policy stated in the booking form. Participants are strongly advised to take out independent travel insurance, including cancellation insurance. When refunding credit card bookings or bank transfer payment please be advised that a £5 administration fee will be applied. In the case of bank transfer refunds ID.Net will not be liable for bank charges.Confirmation* I have read and understood the Cancellation Policy and agree to be bound by its terms. Signature*Your full nameWould you like a copy of your form emailed to you?Enter your email in this box and we will send you a copy.