Personal Information

Full Name: *

Preferred Name:

The preferred name is the name by which a person identifies and wishes to be called, which may differ from the name on official documents

Title:

Gender: (Select one option)

Cisgender woman (A person assigned female at birth who identifies as a woman)

Transgender woman (A person assigned male at birth who identifies as a woman)

Cisgender man (A person assigned male at birth who identifies as a man)

Transgender man (A person assigned female at birth who identifies as a man)

Non-binary (A person whose gender identity does not fit exclusively as male or female. They may identify with a mix of genders, no gender, or a gender outside the traditional binary)

Prefer not to disclose

Nationality: *

Country of birth

CPF number:

if Brazilian, Fill in the format 000.000.000-00

Confirm CPF number:

RG number:

if Brazilian

Passport number: *

if foreigner

Confirm Passport number:

Date of birth:

Day *

Month *

Year

Residential Address

Country of Residence: *

Contact

Phone number: *

Phone number with DDI

WhatsApp number:

WhatsApp number with DDI

E-mail: *

Full name of emergency contact:

Relationship with Emergency Contact:

Emergency Contact Phone Number:

WhatsApp number with DDI

Disability Information

Do you have a disability? *

Yes

If yes, specify:

Do you use any assistive device for mobility? *

Yes

If yes, specify:

Do you require accessible printed materials? *

Yes

If yes, select the preferred format

Organization Information

Organization Name:

Fill in this field if you are affiliated with an entity or representing a company or organization

Country of the Organization:

Position in the Organization:

Travel and Documentation Information

Do you require an invitation letter for a visa? *

Yes

Do you require a sponsorship letter for a visa? *

Yes

Choose your participation modality:

You will be participating? *

Roommate Code

Fill in the registration code of the participant with whom you will share a room. If you choose the double room option without indicating another participant, your partner will be chosen randomly, respecting the rule that they must be someone of the same gender.

Gala Dinner *

Yes (+107,16$)

Cancellation Policy:

Once payment is made, cancellations will not be possible, except in cases of visa denial. Refunds will only be processed upon submission of the visa refusal document. Please ensure all information is correct and that you will be able to attend the event.

Declaration and Signature *

I confirm that all the information provided is true and that I am aware of the cancellation policy.

Registration Form!World Blindness Summit

Choose your participation modality:

Registration Form!
World Blindness Summit