Common Bond Institute

2016 R C Email Registration Form – Subsidy

Common Bond Institute
Email Version

~ Subsidized ~

(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: ( * Contact us to determine program fee)

1) [ ] 3 day FULL Conference Program: November 1-3
2) [ ] 1-Day Conference OPENING DAY ONLY: November 1
3) Farewell Dinner Party: November 3
[ ] $ 30

– A minimum deposit of $50 must accompany this form.
– Registration is not confirmed until payment is received.
Space in the conference is limited and on an as-available basis.
– For convenience, fees may be wired directly (contact CBI for wiring instructions).
– Make checks or money orders (US$ only) payable to:

3-Day Full Conference (Nov. 1-3) __________
1-Day Conference Opening 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 by PayPal
Cancellations: received in writing before 10-9-2016 will be charged a $25 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.
Common Bond Institute
Steve Olweean, Conference Coordinator
12170 S. Pine Ayr Drive, Climax, MI 49034 USA
Ph/Fax: 269-665-9393 Email: Website: