Common Bond Institute

2016 R C Email Registration Form

Common Bond Institute (CBI)
Email Version

(copy and paste text into an Email to complete and return)

International Conference on

Refugee Crisis in Europe and Middle East:
“Sharing Tools for Humanitarian Response”

November 1-3, 2016 ~ Freiburg, Germany

Conference Details at:

CONTACT INFORMATION: (Include Email and Phone)

NAME: ____________________________________________________

ADDRESS: __________________________________________________

City_________________________ State__________________________

Zip Code____________ Country__________________________________

PH ____________________ FAX_________________ CELL _______________

EMAIL_____________________________ WEB _________________________

* [ ] I do NOT wish to be included in conference roster distributed to participants (address, phone, & Email only)


REGISTRATION FEE: (See types of registration and fees below)

1) 3 day Full CONFERENCE PROGRAM: November 1-3
[ ] $325 (293 EURO) General Registration
[ ] $225 (203 EURO) Full-time student
(proof of Full-Time Student status required at registration & check-in
[ ] $100 (90 EURO) General Registration
3) Farewell Dinner Party on Nov. 3:
[ ] $ 30 (27 EURO)
SUMMARY OF DISCOUNTS available off full cost Conference Program Fee:
A) Early Registration: $25 (22 EURO) off 3-Day Full Cost Program fee by 10-9-16 (see above)
B) Presenters: 20% off 3-Day Full Cost Program fee (excludes accommodations)
C) Full-Time Students: $100 (90 EURO) off General 3-Day Full Cost Program fee.
Proof of current full-time status required at registration and at on-site check-in.
D) Groups: $25 (22 EURO) discount each off 3-Day Full Cost Program fee for groups of 3
or more registering together (at the same time).
E) Discount for generating additional Full Cost registrations: To assist in our efforts
to subsidize attendance from economically impoverished societies, we offer a
$30 (27 EURO) discount to individuals for each additional 3-Day Full Cost General or Student
registration they generate (cannot be combined with group discount “D”).
Registrants should list your name & address on their form to qualify you for discount.
Rebates are given after all final payments are received.
Note: Contact Common Bond Institute for information on options D and E

– A minimum deposit of $100 (90 EURO) must accompany this form.
– Full registration fee should be received by October 9, 2016 to qualify for Early registration fee.
– Registration is not confirmed until payment is received.
Space in the conference is limited and on an as-available basis.
– For convenience, fees may be wired directly (contact CBI for wiring instructions).
Make checks or money orders (US$ only) payable to: COMMON BOND INSTITUTE

3-Day Full Conference (Nov.1-3) __________
1-Day Conference Opening Day ONLY (Nov.1) __________
Farewell Dinner Party (Nov. 3) __________

TOTAL CHARGES: __________ *

Amt. Enclosed with registration: __________


* To pay by PayPal CLICK HERE – or see PayPal button on Registration Page at:

COMMENTS: _______________________________________________

METHODS of PAYMENT (choose one): NOTE: registration is NOT confirmed until payment is received (US$ only)
[ ] 1. On-line by PayPal (see above website): For Credit Card or bank withdraw
[ ] 2. By Mail to Common Bond Institute: Check, Money Order, Cashiers Check (US$ only).
12170 S. Pine Ayr Drive, Climax, Mich. 49034 USA
Ph/Fax: 269-665-9393 Email: Web:
* Note: Checks must be received by Oct. 9, 2016 for deposit.
After this use PayPal or wire transfer
[ ] 3. By wire transfer (contact us for instructions)
[ ] 4. On-site at event: cash and travelers check ($ US dollars or Euro only), or PayPal

Cancellations: received in writing before 10-9-2016 will be charged a $75 (67 EURO) 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 Institute 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 Institute 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.

Common Bond Institute
Steve Olweean, Conference Coordinator
12170 S. Pine Ayr Drive, Climax, MI 49034 USA
Ph/Fax: 1-269-665-9393 Email: Website: