RESET Summit 2025 - Guest Intake Form - Emotional Reset Center

Personal Information

Please provide your personal information. This will be used for identification and communication purposes only. Your privacy is important to us

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First Name *

Middle Name

Last Name *

Birthday *

Contact Number

Travel Information

Please upload your passport and flight details. Your passport information will be kept confidential and used solely for event-related purposes by the organizers.

Departure Date *

Return Date *

Passport

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Flight Details *

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Please ensure that your uploaded flight details include date, time of arrival/departure, and airline information.

Travel Insurance Information

Note: All attendees are highly recommended to submit proof of travel insurance before departure. If you do not have coverage yet, please inform
the organizing team and they can help you secure one.

Do you have valid travel insurance for the duration of the program?YesNo

If you already have one, kindly upload your certificate or policy below.

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Accommodation Prior to the Event

*Please provide the details of your accommodation prior to the event: (If arriving before the start of the event on April 24)

Accommodation Name or Type *

Accommodation Address *

Check-in Date *

Check-out Date *

Emergency Contact Person

Please provide the name, relationship, and contact details of someone we can reach in case of an emergency during the event.

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First Name *

Middle Name

Last Name *

Emergency Contact Number *

Relationship to Emergency Contact

Health & Dietary Requirements

Please share any relevant health conditions or dietary restrictions we should be aware of to ensure your safety and comfort during the event.

Medical Condition/s

Accessibility Need/s

Kindly provide the account of any other messaging apps you use (e.g., WhatsApp, Viber, Messenger) for communication purposes.

Other Messaging Apps *

Legal Consent and Liability Waiver

By registering for and participating in the RESET Summit, I acknowledge and agree that I am voluntarily attending the event and assume full responsibility for my health, safety, and well-being throughout its duration. I understand that the organizers, including RESET Summit, its partners, sponsors, staff, and affiliated entities, will not be held liable for any personal injury, illness, medical emergency, accident, loss, or any untoward incident that may occur during or as a result of my participation in the event.
I hereby release and discharge the organizers from any and all claims, liabilities, or causes of action arising out of or in connection with my participation, except in cases of proven gross negligence or willful misconduct.
By attending, I confirm that I am physically and mentally fit to participate in the activities of the RESET Summit and that I have taken any necessary precautions or medical advice prior to attending.

Legal Consent and Liability WaiverAgree

I agree to the event’s privacy policy and consent to the collection of my information for event purposes.By checking this box, you confirm that you consent to the use of your data for event planning.

I grant permission for event photography and video recordings that may include my image.YesNoChoose ‘Yes’ if you allow photos and videos of you to be taken during the event for promotional purposes.

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Guest Intake Form

3rd International RESET Mental Health Summit 2025 – Guest Intake Form

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