last updated 7/14/2020

14th INTERNATIONAL DABROWSKI CONGRESS 

August 12 – 14, 2021

GCP Conference Campus

Exploring the Theory of Positive Disintegration

Registration Form

Instructions:
You may register for the Dabrowski Congress in a few ways:

• To pay by credit card, click here. 
  
  
   
• By mail – send this form along with a check payable to Gifted Conference Planners to the address below. Please fill in all relevant blanks for each attendee. If you wish to include notes or special instructions, please use a separate sheet or the back of the page. Gifted Conference Planners, c/o 7 North End Rd., Townsend, MA 01469-1124
• By waiver - we will waive the registration fee for anybody who cannot afford it upon request.

Check your cart:  

If you have questions, you can reach us by email or leave a message at 1-978-300-5432.
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General Information:
Name:
Street Address:
City: _________________State/Province: ______Postal Code: ____________
Country: ______________Phone Number: _____________Fax: ______________
Email: ______________________Institution (if any): ________________________
Total Fees: $_____.00 + Donation (optional): $______ = Total Amount Enclosed: $________
I am registering a family and would like apply the discount:
Reminder: Checks should be made payable to Gifted Conference Planners.

Attendee Information:
Number of Attendees: ___ (Include additional copies of the third page as needed.)

Attendee 1:
Name:
__________________________
Group: Adult ___ Student ___
Email (if
different): __________________________
Institution:
Sessions Attending:
Thursday ___ Friday ___ Saturday ___
Please tell us your primary role(s):
Educator ___ Therapist ___ Researcher ___ Student ___ Parent ___
Fees: $______ 

Attendee 2:
Name:

__________________________
Group: Adult ___ Student ___
Email (if
different): __________________________
Institution:
Sessions Attending:
Thursday ___ Friday ___ Saturday ___
Please tell us your primary role(s):
Educator ___ Therapist ___ Researcher ___ Student ___ Parent ___
Fees: $______ 

Attendee 3:
Name:
__________________________
Group: Adult ___ Student ___
Email (if
different): __________________________
Institution:
Sessions Attending:
Thursday ___ Friday ___ Saturday ___
Please tell us your primary role(s):
Educator ___ Therapist ___ Researcher ___ Student ___ Parent ___
Fees: $______ 

Attendee 4:
Name:
__________________________
Group: Adult ___ Student ___
Email (if
different): __________________________
Institution:
Sessions Attending:
Thursday ___ Friday ___ Saturday ___
Please tell us your primary role(s):
Educator ___ Therapist ___ Researcher ___ Student ___ Parent ___
Fees: $______ 

#prices and details subject to change without notice