Common Bond Institute
Subsidized Program Fees
(copy and paste text into an Email to complete and return)
Annual International Conference on
"Transgenerational Trauma:"Communal Wounds and Victim Identitites
September 19-22, 2012 ~ Amman, Jordan
Details at: www.cbiworld.org/Pages/Conferences_TT.htm
CONTACT INFORMATION: (Include Email and Phone)
ADDRESS: __________________________________________________ City______________________
State________________________________ Zip Code_________ Country__________________________
PHONE _________________________ FAX______________________ CELL _____________________
EMAIL_________________________________________ WEB _________________________________
* [ ] I do NOT wish to be included in conference roster distributed
to participants (address, phone, & Email only)
HOUSING INFORMATION: Accomodation cost is the same for all participants
*Hotels rent by individual person rather than by the room. Rooms & prices are for DOUBLE (shared) occupancy.
- For single room add $25 per day ($100 for 4 night package).
Please indicate if you have a specific roommate. Note: If you are not in a single and a roommate is not listed, one will be assigned.
Full description of what is included on website at: www.cbiworld.org/Pages/Conferences_TT_Fees.htm
Please indicate one preference for each option below.
__Single / __Male __Female
/ __Smoking __Non-smoking
(All meeting spaces are non-smoking)
Specific Roommate: ____________________________________________________
Dates Of Attendance
(required): Arrival & departure dates from Hotel:
Arrive: _______ Depart: _______
REGISTRATION FEES: (See types of registration & fees for Subsidized Registrations below)
Common Bond Institute for discounted fee based on country citizenship &
(Items listed under Hotel and Meals are NOT included under this fee)
4-day Conference Only - September 19-22: ________
2) Hotel: (4 nights room, meals, & farewell dinner party at Sadeen Hotel - conference site):
[ ] $480 (see what is included at: www.cbiworld.org/Pages/Conferences_TT_Fees.htm)
3) MEALS: (included in Hotel fees, but NOT in Conference Only fee)
[ ] $205 Full Meal Package (4 days at 3 full meals per day, including farewell dinner party)
[ ] $ 20 Farewell dinner party Saurday night September 22
[ ] $ 16 Individual meals (contact CBI directly for individual meal purchases)
~ SUMMARY OF CHARGES ~
A minimum deposit of $100 must accompany this form. Full registration fee should be received by August 19, 2012 to qualify for early registration fee. For convenience, fees may be wired directly (contact CBI for wiring instructions).
Make checks or money orders (US$ only) payable to: COMMON BOND INSTITUTE
Conference Program: __________
Hotel (4 nights room & meals): __________
(If Single Room add $25 per night): __________
Meals Package (4 days of conf meals): __________ (breakfast, lunch, & dinner)
Farewell Dinner Party: __________
Other Additional for: _Breakfasts___ __________ [ ] Thur. [ ] Fri. [ ] Sat. [ ] Sun.
Other Additional for: _Lunches_____ __________
[ ] Wed. [ ] Thur. [
] Fri. [ ] Sat.
Other Discounts for: _Dinners_____ __________ [ ] Wed. [ ] Thur. [ ] Fri. [ ] Sat.
TOTAL CHARGES: __________ *
Amt. Enclosed with registration: __________
AMOUNT REMAINING DUE __________ *
* To pay by PayPal see button link on CBI website at: www.cbiworld.org/Pages/Conferences_TT_Fees.htm
METHODS of PAYMENT (choose one): NOTE: registration is NOT confirmed until payment is received
[ ] 1. On-line by PayPal (see above website): For Credit Card or bank withdrawl
[ ] 2. By mail to Common Bond Institute: For Check, US Money Order, or Cashiers Check)
12170 S. Pine Ayr Drive, Climax, Mich. 49034 USA
Phone/Fax: 269-665-9393 Email: SOlweean@aol.com Web: www.cbiworld.org
* Note: Checks must be received by September 1, 2012 for deposit. After this date use PayPal or wire transfer
[ ] 3. By wire transfer (contact us for instructions)
[ ] 4. On-site at conference (cash or travelers check only - US dollars or Jordanian JD only)
in writing before 8-10-2012 will be charged a $100 administrative fee. No
refunds can be made for cancellations thereafter.
Assignments: You may also assign your registration to someone else for participation at no charge (assignments must be made prior to the conference date in person and confirmed in writing directly to Common Bond Institute).
Disclaimer: Deposit indicates agreement to terms and releases Common Bond Inc. from any responsibility, including but not limited to injury, damage, or loss suffered by anyone taking part in the conference program. Participants assume responsibility for all risks involved, expected or unexpected. Neither Common Bond Inc. nor the conference organizers are involved in the travel business and, therefore cannot accept responsibility for any losses or damage to persons or property as a consequence of travel, lodgings, civil disturbance or any other person servicing this conference. Nor shall these parties be responsible for any extra expenses or losses arising from delays, cancellations, substitutions, or any act or omission whatever by airlines or other transportation companies.