APPLICATION FORM FOR THE
POWER & LEADERSHIP CONFERENCE
(POWER LAB)
Is this
going to be an online application or a form to be printed, filled out,
and mailed/faxed in? Also,
doesn't this need to offer other things or are we to have multiple applications?
Please
print this form, fill in all requested information, and either
fax to
888-888-0001
or mail to
Power & Systems, Inc.,
PO Box 990288,
Boston, MA 02199-0288.
Questions may be emailed to;
info@power.com
or call 888-888-8888.
Date of course you will be attending
Name
Age* 1 Male* 1 Female* (*requested for program development only)
Position/Title
Organization
Address
City State/Province Zip/Postal Code
Tel. No. E-mail
How did you learn about this program?
Name you want on your name tag
My main purpose in attending this program is
Payment Information
The course fee for
the April 29-May 4, 2001 session is $3,000; the course fee for the October
21-26, 2001 session is $3,500. The course fee includes tuition, materials,
and living costs. A $250 non-refundable deposit must accompany this
application. You need to bring an additional $20 in cash for use in
the conference.
Cancellations/transfers
made 22-45 days prior to the starting date will be charged an additional
$250. Those made 4-21 days prior to the starting date will be charged
50%. Those made 3 business days or less prior to the starting date will
be charged the entire fee.
Registrants who
do not cancel in writing and who do not attend the program are liable
for the full fee.
Payment: 1 Check
1 Purchase Order
1 AMEX 1 MC 1 Visa
Card no.
Expiration date: Signature:
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