Registration form 21st dialogue conference July 6th 2019

Please fill in and return before June 30th 2019 via this web form.

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Name *

Last name *

Email address *

Number of persons: *

Name and email address of the other participant (s) (if applicable):

Are you eligible for a youth discount (age <25 years)? *YesNo

Preferred language program booklet (multiple choice possible): *DutchEnglish

Preferred language during dialogue discussion: *DutchEnglishno preference

Number of people for Normal lunch? (numbers only) *

Number of people for vegetarian lunch? (numbers only) *

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For the conference I will transfer an amount of € 25.00 per person (young people from < 25 years € 15.00) to bank account NL73 SNSB 0927 6534 94 t.n.v. NJI Dialogue Foundation 21st Dialogue Conference July 6, 2019 and your name.

Please send your  questions to