2016 Conference Registration Form Your InformationName* First Last Email* PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Conference InformationBREAKFAST (8:15 am) Please let us know if you will be attending:*Select belowYesNoLUNCH (12:30 pm) Please let us know if you will be attending:*Select belowYesNoWORKSHOPS I (9:45 - 11:05 am)*Select belowNONE - I'm not attending any workshops during this timeNutrition and Wellness for Cancer Survivors - Stacy Kennedy & Dr. Russell KennedyBeing a Caregiver – Navigating the Journey - Katie BindGoodbye Brain Fog! Strategies to Help Get Your Thinking Back on Track - Heather PalmerJournaling Toward Wellness - Claire WillisExclusively for Young Adults - Samantha Eisenstein WatsonWORKSHOPS II (11:25 - 12:45 pm)*Select belowNONE - I'm not attending any workshops during this timeWhen Your Spouse Has Cancer: How to Be a Loving Partner and Caregiver During Treatment and Thereafter - Kevin L. MurphyNavigating Health Insurance - Joanna MoralesA Fitness Plan for Cancer Survival - Josie GardinerSurvivorship Care Plans: Present and Future Perspectives - Katherine WalshWORKSHOPS III (2:45 - 4:00 pm)*Select belowNONE - I'm not attending any workshops during this timeBalancing Work and Cancer - Rachel Becker & Joanna MoralesIntroduction to Mindfulness: How the Science and Practice of Awareness Supports Healing - Tara HealeyCouples Regaining Connection after Cancer: From the Living Room to the Bedroom - Tim Cummings & Cynthia MedeirosBeyond Cancer Survival: Parenting for Health - Aurelie Catherine CormierThe Art of Living Conference Tickets* Price: $35.00 Quantity: Total $0.00 PhoneThis field is for validation purposes and should be left unchanged.