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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