Common Bond Institute (CBI)
Email Version
REGISTRATION FORM

~ SUBSIDIZED FEE ~

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

7th Annual International Conference on
Transgenerational Trauma:
Communal Wounds and Victim Identities
October 18-20, 2018 ~ Amman, JORDAN
Conference Details at: www.cbiworld.org/conferences/tt/

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)

HOUSING INFORMATION:
NOTE: Hotel rent by individual person rather than by the room
Rooms & Prices are for DOUBLE (shared) occupancy only. Please indicate if you have a specific roommate.
For Single room add $25 per night ($75 for 3 nights).
* If you wish a double and a roommate is not listed we will first attempt to match you with a roommate. However if none is available the single room rate will apply.
– Additional Nights before or after the program are available when registering through Common Bond Institute. Contact us directly to book additional nights.
Full description of fees and what is included at:
www.cbiworld.org/conferences/tt/registration/

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 FEE: (See types of registration and fees below)

1) HOTEL Fees:  3 days/3 nights: October 18-20
Note: Conference program begins the morning of Oct. 18.
For less or more nights at hotel please contact CBI.

Program and 3 nights room (18th, 19th, 20th) + breakfast and unlimited Internet
This rate is per person for Double shared occupancy room

Add $25 per night for Single room (i.e. additional $75 for 3 nights)
[ ] $246   Price includes all taxes and service fees
______________________________________________________
2) 3-day Conference Program ONLY – October 18-20:
(Hotel NOT included under this option)
* Contact CBI directly to determine subsidized program fee you qualify for at: SOlweean@aol.com
Confirmed Subsidized Fee: ____________
______________________________________________________
3) FAREWELL DINNER PARTY: October 20 – Includes all taxes & service fees
[ ] $ 28  (20 JD)
______________________________________________________

~ SUMMARY OF CHARGES ~
– If reserving a hotel room a minimum deposit of $75 must accompany this form.
– Registration is not confirmed until payment is received, and hotel rooms and meals can not be reserved without advanced payment. Space in the conference and in the hotel is limited and on an as-available basis.
– For convenience, fees may be wired directly (contact CBI for wiring instructions).
Make checks or money orders (US$ only) payable to: COMMON BOND INSTITUTE

Conference / Hotel “Package”                     __________
(If Single Room add $25 per night):          __________
Additional ___ Room nights                      __________
“Conference ONLY” (no Hotel items)        __________
Farewell Dinner Party Sat. Oct. 20             __________

TOTAL CHARGES:                                        __________ *

Amt. Enclosed with registration:                __________

AMOUNT REMAINING DUE                      __________ *

* To pay by PayPal CLICK HERE – or see PayPal button on Registration Page at:
www.cbiworld.org/conferences/tt/registration/

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
12170 S. Pine Ayr Drive, Climax, Mich. 49034 USA
Ph/Fax: 269-665-9393 Email: SOlweean@aol.com Web: www.cbiworld.org
* Note: Checks must be received by Oct. 2, 2018 for deposit and clearing.
After this please use PayPal or wire transfer
[ ] 3. By wire transfer (contact us for instructions)
[ ] 4. On-site at event (cash or travelers check only – US dollars or Jordanian JD only)

__________________________________________________
Cancellations: received in writing before 9-18-2018 will be charged a $50 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: SOlweean@aol.com Website: www.cbiworld.org

Secured By miniOrange