Registration Form of Global Dialogue 2010
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The theme of Global Dialogue 2010 is:
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Participants to the Global Dialogue 2010 must register. There are no registration fees. One registration per form. Register by email at: globalcommunity@telus.net You may also register by post office mail. See postal address below.

Participants submitting research papers to the Global Dialogue 2010 must submit the Paper Submission Cover Sheet. If there are more than one authors please list them all in the message area. Send an email message if needed. If you have a long abstract please send it by email. If you wish to communicate with Global Dialogue 2010 please send us a message using the contact information below.




Ms. Mr. Mrs. Dr.
First name: ________________________________________ Last Name: _____________________________

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Title/Position: ______________________________________ Department: ____________________________

Organization: ______________________________________________________________________________

Address (street number and name):
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City: ____________________________________________________________

Province/Territory: _________________________________________________

Country: _________________________________________________________

Postal Code: _____________________________________________________

Telephone: _______________________________ ext: _______________ Fax: ________________________

E-mail: __________________________________________________
Website: _________________________________________________

Sector:
 Federal Government  Provincial Government  Municipal Government
 Corporate  Academic  NGO  Media  Student
 Other (please specify): ____________________________________________________________________
Are you making a presentation? Yes No
If yes, title of presentation:_________________________________________________
Short summary: _________________________________________________
____________________________________________________________________
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Are you organizing a Workshop Session in your community? Yes No
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If yes, do you need help other than monetary help? Contact us if needed.
Describe your Worksho Session (goal, issue(s), place, participants, day and time, results, recommendations, etc.):
____________________________________________________________________
____________________________________________________________________
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Do you wish to participate in a Discussion Roundtable on Internet? Yes No
What issue(s)?
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