Registration - Colloquium
on Global Diversity
PAYMENT BY
CREDIT CARD
This online form is for use with credit
card payment only . We do accept checks, but are not able to accept checks
for registrations online.
To pay by check, you will need to
print the registration form and mail it with your check to our office.
REGISTRANT INFORMATION
REQUIRED FIELDS
Ms.
Mrs.
Dr.
Mr.
First Name
Last Name
Title/Position
Company
Mailing Address1
Mailing Address2
INCLUDE CITY, STATE, ZIP CODE Country
Tel (include country code)
Fa x
E-mail
Re-enter E-mail
REGISTRATION FEE
We cannot process your registration
without payment either by credit card or bank check.
US
$450 -
( includes February 25 Dinner Roundtables and February 26
Colloquium)
No refunds after February 4, 2010
METHOD OF PAYMENT
REQUIRED FIELD Note:
All credit card charges will be
processed by WREI
Pay by Bank Check
(note: this process
cannot be completed online)
CREDIT CARD PAYMENT
Cardholder Name
Card Type
Select
American Express
Mastercard
Visa
Account Number
Expiration Date (Month/ Year)
Signature of Cardholder
Important Note: The Global Summit of Women is a non-profit
program whose fiscal agent is WREI (Women's Research and Education
Institute) (USA). All credit card charges will be processed
by WREI.
CANCELLATION POLICY: Notice of cancellation must be
submitted in writing prior to February 4, 2010. Please email
your request to
summit@globewomen.com. In order to be honored,
requests for refunds must be received prior to the February 4, 2010
deadline.
HOTEL
ACCOMMODATIONS: Algonquin Hotel:
A special rate of $199 + tax is available for Colloquium
participants. Please
call 1-212-419-9318 or email
jgeorge@algonquinhotel.com
before
January 26
and reference the
Global Summit of Women
to receive the discounted rate.
The hotel is located at
59 West 44th Street th Avenues) in
New York New York .
SUMMIT OFFICE -
CONTACT INFORMATION Mailing address: Global Summit of Women
1100 G Street, NW, Suite 700 Washington, DC 20005 USA
