"*" indicates required fields Please indicate if you will be joining Mind & Life in IndiaYour Name* First/Given Name Last/Family Name Your Email Address* RSVP* Yes, I will be attending No, I’m unable to attend Wonderful! We are delighted that you will be joining. Kindly provide additional information to secure your spot. General Information & Communication Your Name*(as you would like it to appear on your nametag)Full, Legal Name*(as listed on your passport) First/Given Name Middle Name (if any) Last/Family Name Phone number*(Please include the country code for non-US numbers)WhatsAppIf need be in India, we will be communicating through WhatsApp. Is the above phone number connected to WhatsApp? Yes, my existing phone number is connected to WhatsApp No, I use a different messaging service Messaging optionsWhat service do you use for messaging? (iMessage, Signal, etc.)Your Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Assistant Name(if any)Assistant Email Address(if any, to be CC:’d on any future communications about the Dialogue) Would you like your name to be included on a guest list to be shared with other attendees?* Yes, please share my name with other guests No, please do not share my name Emergency Contact In case of emergency, the following person may be contacted:Emergency Contact Name* First Last Emergency Contact Relationship*Emergency Contact Phone number*(Please include the country code for non-US numbers)Accessibility & Medical InformationAllergy InformationDo you have any food allergies, medical allergies, or conditions that would be critical to know in an emergency? All information is kept confidential except as needed in an emergency, except for food allergies that will be shared with providers.Accessibility Accommodations If you have a disability and require accommodation in order to fully participate in this event, please check here. You will be contacted by Mind & Life staff to discuss your specific needs. Indian Visa InformationVisa Status*(See this PDF from the event website for details) I hold an active Indian Visa that will be valid for our October 2025 dates I do not have an active Indian Visa and will apply for one (deadline to submit an approved visa to Mind & Life is July 7) Privacy and Image RightsPrivacy Policy*Mind & Life’s use of any information submitted during this registration process is governed by the terms outlined in the Mind & Life Privacy Policy. I understand and agree Photography and Videography Consent Policy* In order to create an historical record of this event, some of the proceedings will be photographed, filmed, and livestreamed. By registering, you grant Mind & Life permission to use your image. If you have any specific concerns related to the use of your image, please contact ekellner@mindandlife.org prior to registering. I understand and agree
