Annual Conference: Registration Page – International Brain Injury Clubhouse Alliance

2024 Annual IBICA Virtual Conference: Clubhouse Registration

Welcome! This registration form is for an organizational representative to submit one registration form for their clubhouse- not an individual registration form. Are you the designated representative from an IBICA clubhouse? If yes, then you are in the right place!

Step 1 of 3

Your Name *

First

Last

Position/Job Title *

Email *

Primary Phone Number *

Mobile Phone Number *

Please provide a mobile phone number for any contact necessary during the conference.

Clubhouse Name *

Comment

2024 Annual IBICA Virtual Conference: Clubhouse Registration

Help us plan well by estimating your clubhouse participation.

Registration Payment Information