Common Bond Institute
Email
Version of
REGISTRATION
FORM
Subsidized Program Fees
(copy
and paste text into an Email to complete and return)
1st
Annual International Conference on
"Transgenerational Trauma:"Communal
Wounds and Victim Identitites
September 19-22, 2012 ~ Amman, Jordan
Conference
Details at: www.cbiworld.org/Pages/Conferences_TT.htm
CONTACT INFORMATION: (Include Email and Phone)
NAME: _______________________________________________________________________________
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.
Room: __Double
__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)
1)
CONFERENCE PROGRAM:
*Contact
Common Bond Institute for discounted fee based on country citizenship &
residence.
(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
COMMENTS: ____________________________________________________
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)
