* 1. First Name

* 2. Last Name

* 3. Address

* 4. Country

* 5. Email

* 6. Mobile phone (optional) include country code

* 7. Are you a member of your National Occupational Therapy Association

* 8. If Yes, which Association?

* 9. Are you an Individual member of WFOT?

* 10. Describe how you are contributing to your workplace/professional community. (Max: 250 words)

* 11. Describe how your participation at the congress can positively affect your role in your workplace/ professional community. (Max: 250 words)

* 12. Describe the knowledge you are hoping to gain and how this will impact your workplace/professional community. (Max: 250 words)

* 13. Outline your plan for how you will share what you learn at the congress with your workplace/professional community.

* 14. If you hold a leadership role within your association or place of work/study, please describe how congress attendance will benefit your role. (Max: 250 words)

* 15. Have you submitted an abstract for presentation at the Congress?

* 16. I agree to submit a report to the Congress Office within 2 months of the congress, reporting on my experience and the impact of attending the WFOT Congress 2018 (failure to do so may lead to a refund being sought by WFOT).

* 17. I agree to information provided in my report to be used by WFOT on its website, social media, e-newsletters and other publications for promotional/educational purposes.

* 18. I agree to submit an article to the journal/newsletter of the funding organisation for consideration for publication, if requested

* 19. I agree to all terms and conditions (link to T&C).

* 20. Please outline the type of support and assistance required in terms of travel, accommodation, registration and daily allowance.

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