Registration form please complete and return the Registration Form directly to Farishta Dinshaw, costi immigrant Services, via email at

A Conference on Gambling, Culture, Community and Intervention:

Resilience and Recovery

Tuesday, March 5, 2013

9:00 am to 4:00 pm  Registration at 8:30 a.m.

Ramada Plaza Hotel, 300 Jarvis Street, Toronto

REGISTRATION FORM

Please complete and return the Registration Form directly to Farishta Dinshaw, COSTI Immigrant Services, via email at [e-mail], or by fax to 416-244-7299. There is no registration fee; however, Registration Forms must be submitted no later than Monday, February 24, 2013.

Name (Last):________________________________________ (First) _______________________________

Position: _______________________________________________________________________________

Organization: ___________________________________________________________________________

Address: _______________________________________________________________________________

_______________________________________________________________________________________

Work Phone: ________________Cell: ____________________E-mail: ______________________________
WORKSHOPS

Please select the two workshops that you would like to attend in the afternoon breakaway session:

Workshops:	SESSION 1 1:00 pm	SESSION 2 2:00 pm
Strategies for Successful Support Groups Maria Benevides
Online Gambling: A Problem Just a Click Away Farishta Dinshaw
Multicultural Conceptions of Gambling and Problem Gambling Jenney A. Josipovic
Sharing Ideas: Wellness Strategies in Clinical Counselling Negar Sadeghi and Peter Chen

MEALS

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  Light breakfast
  
• 
  Lunch: Please indicate: Non-vegetarian _____ Vegetarian _____ Special Dietary Needs: ______________
  
  
  

TRAVEL & ACCOMODATION

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  The hotel is a ten-minute walk from the College subway (located on the Yonge line).
  
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  Driving instructions and map are available on the hotel website: www.ramadaplazatoronto.com
  
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  Daily hotel parking rate is $11.30.
  

OTHER INFORMATION

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  Please describe any special needs (eg. wheelchair access): ________________________________
  
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  Will you be bringing resources about your agency to share with other participants? Yes ____No ____