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Asia Pacific (PITH) 2025 Conference - Registration Form
Phuket, Thailand | Boat Lagoon Phuket Resort | 25-28 July 2025 Registration is open to all those who are part of or associated with the IBCM Network of Brethren churches worldwide. 1. Registration closes on June 30, 2025. 2. A deposit is required as part of
all
registration submissions. 3. Full payment is required by March 31, 2025. 4. After March 31, 2025, all registrations must include the payment of the full conference fee. 5. Early Bird closes January 31, 2025. Prices will increase by $30 after that date. Please complete this registration form in English if possible. If you are having problems with submitting this form or processing your payment please contact us at conference@ibcm.net. We look forward to seeing you in Phuket, Thailand, in July 2025. The IBCM Network Team
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What you need to complete this registration form:
1. Passport
2. Credit/Debit Card - to pay your non-refundable deposit
3. Know if you need to apply for a Visa. To check go to: https://thaievisa.go.th/
PERSONAL DETAILS
Registering For
*
Individual
Couple
Family
Group
You need to fill in a separate form for each separate person participating in the conference (even infants).
Couple/Family/Group ID
Couple/Family/Group ID = Family/Last Name/Group Name
Title
*
Mr
Mrs
Ms
Miss
Dr
First/Given Name (as on passport)
*
Last/Family (as on passport)
*
Email
*
Email
Confirm Email
Mobile Phone
*
Will be used by IBCM Network staff for arrival and departure purposes only.
Residential Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Country of Residence
*
Select Country
Afghanistan
Albania
Algeria
Andaman & Nicobar Islands
Andorra
Angola
Anguilla
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Congo {Democratic Rep}
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland {Republic}
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar, {Burma}
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion Island
Romania
Russian Federation
Rwanda
St Kitts & Nevis
St Lucia
Saint Croix
Saint Thomas
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Yemen
Zambia
Zimbabwe
Date of Birth
*
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
MM
1
2
3
4
5
6
7
8
9
10
11
12
/
YYYY
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Gender
*
Male
Female
Is your husband/wife coming with you?
*
Yes
No
Please note if you answer "YES" you still need to complete a separate registration form for your spouse. The details below just lets us know both names of each couple.
Spouse Title
*
Mr
Mrs
Ms
Miss
Dr
Spouse First/Given Name
*
Spouse Last/Family Name
*
Do you need translation from English into another language?
*
Yes
No
Languages offered are: Thai, Indonesian, Korean
Language
*
Language
Thai
Indonesian
Korean
Language you need translation for
Are you willing to translate at the conference?
Yes
No
Languages offered are: Thai, Indonesian, Korean
Language I will translate into is
*
Language
Thai
Indonesian
Korean
Dietary Requirements
Diabetic
Gluten Intolerant
Lactose Intolerant
Nut Allergy
Vegetarian
Other / Further Details
Further Dietary Information
PASSPORT DETAILS
Passport - Country of Issue
*
Select Country
Afghanistan
Albania
Algeria
Andaman & Nicobar Islands
Andorra
Angola
Anguilla
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Bermuda
Belize
Benin
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Congo {Democratic Rep}
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland {Republic}
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar, {Burma}
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Reunion Island
Romania
Russian Federation
Rwanda
St Kitts & Nevis
St Lucia
Saint Croix
Saint Thomas
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Passport Number
*
Passport - Date of Issue
*
Passport - Expiry Date
*
CHURCH & MINISTRY
Church attending
*
Christian organisations you work with (if any)
Nature of personal ministry
TRAVEL DETAILS
Do you need a Visa in advance?
*
Yes
No
You must apply for a visa yourself. To do this go to https://thaievisa.go.th/
Do you need a formal letter of invitation to the conference?
*
Yes
No
Do you need transport from the airport to the conference centre?
*
Yes
No
Transport will be provided from the airport to the conference centre on Friday July 25. Return transport will be provided to the airport on Monday July 28.
GO-SERVE MISSION TRIPS
Do you intend to participate in a short-term mission trip following the conference?
*
Yes
No
Short term mission trips covering different ministries in surrounding countries including Thailand, Malaysia, and the Philippines will be offered following the conference to a limited number of participants. The mission trips will cost between US$300-$1000. If you select yes more details and a mission trip registration form will be sent to you.
CONFERENCE OPTIONS
Conference Elective Track Selection
*
How to Counsel Others
Creating a Church Culture of Care
Conselling Issues
Caring as Mission
Youth Identity
During the conference there will be a number of elective sessions related to the above areas.
CONFERENCE FEES (per person)
All amounts are in US dollars.
Registration closes on June 30, 2025.
Early Bird closes on January 31, 2025.
Are you applying for a supported place?
*
Yes
No
If you are applying for a supported place you are still required to fill in the conference details and pay a $50 deposit.
What level of support are you requesting?
*
Half Conference Fee
Full Conference Fee
Supported places and the amount of support able to be given to each will be limited by the funding that is available.
Support is only available for eligible participants from the Asia Pacific region.
Do you need Medical Travel Insurance?
*
No
Yes (50) - I am under 70
Yes (70) - I am 70 or over
Medical insurance will cost $50 each, or $70 if over 70years of age.
If you need to apply for a Visa and don't have your own travel insurance you must select YES.
Fee Options - per person (select one)
*
1 - SHARED - Conference, Accommodation Double/Shared Room [couples choose this option], Transport - (300)
2 - SINGLE - Conference, Accommodation Single Room [one person only, subject to availability], Transport - (360)
3 - CONFERENCE ONLY - Conference, No Accommodation - includes 2 meals each day [lunch & dinner] - (190)
4 - DAILY RATE - includes 2 meals ($70)
5 - CHILDREN - 3 -12 year (150)
6 - INFANT - 0-2 year (50)
All rates are in US Dollars
Days Attending ($70/day)
*
Friday July 25
Saturday July 26
Sunday July 27
Monday July 28
Do you wish to book extra nights at the conference venue?
*
Yes
No
Extra Nights - Double/Shared Room/Night ($50) includes breakfast
*
#1 Wednesday July 23
#2 Thursday July 24
#3 Monday July 28
#4 Tuesday July 29
Extra Nights - Single Room/night ($70) includes breakfast
*
#1 Wednesday July 23
#2 Thursday July 24
#3 Monday July 28
#4 Tuesday July 29
If sharing a room with whom would you like to share?
Would you like to provide financial assistance for the conference or other participants?
*
No
Yes - (50)
Yes - (100)
Yes - (300)
Other Amount
Amounts are in US dollars
Support Amount ($)
*
Total Conference Cost (US$)
What amount would you like to pay now?
*
Deposit - (50) - Non Refundable [also select for infant]
Full Amount
Amounts are in US dollars
Conference Payment (US$)
*
Amounts are in US dollars
Credit/Debit Card
*
Card
Name on Card
Conference Participant List - I am happy to share my name and email address with conference participants?
*
Yes
No
Disclaimer
1. I declare that I am a member or associate of a Christian Brethren church or organisation.
2. I understand that by submitting this form I confirm that the information given on this booking form is accurate and that I recognize that it is necessary for IBCM Network to hold and process the personal data provided for the purposes of IBCM Network and the Asia Pacific (PITH) conference in accordance with our privacy policy (https://www.ibcm.net/about/), and to communicate with me about it.
3. I confirm that I have/will arrange travel insurance either through IBCM Network (above) or by purchasing my own.
4. I confirm that I will pay the balance of the conference fees owing by the due date.
Disclaimer
*
I Agree
Message
Submit