Registration Form for Certificate Program for Negotiating, Collaborating and Leading in Today's World
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Registration Form for
Certificate Program for Negotiating, Collaborating
and Leading in Today's World
July 28-30 and August 19-20, 2010
Courtyard by Marriott Hanover/Lebanon, Lebanon, New Hampshire
Please print this 2-page form, fill out the Registration Form, and Fax it to: 802 457-1501
OR Mail it to: Woodstock Institute for Negotiation, Pomfret Stage Road-Drawer 29, Woodstock, Vermont 05091. Please do not
send this form via e-mail if you are paying by credit card as your information will not be secure.
Name: _____________________________________________ I go by (for Name Tag): __________________
Company/Organization: ________________________________________ Position: ____________________
Street Address: ______________________________________________________________________________
______________________________________________________________________________
City: _____________________________________________ State: _______________ ZIP: ______________
Work Phone: ____ ___________ Home Phone: ____ ___________ Fax: ____ ___________
E-Mail Address: ____________________________________________________________________
Fees:
___ July 28-30 & August 19-20, 2010 $ 1,595.00 $_________
___ Completion of Certificate Program ($225.00 if paid later) $ 195.00 $_________
___ Late Fee if WIN receives payment after July 17, 2010 $ 100.00 $________
Sub-Total $_________
Less Discounts:
___ Early Registration by June 23, 2010 -$ 50.00 $_________
___ Multiple Employees Registering for same program -$ 50.00 $_________
___ Government & Non-Profit Full-Time Employee -$ 300.00 $_________
___ Repeating Entire Program -$ 300.00 $_________
Total Amount Due $_________
Payment:
___ Payment Enclosed ___ Payment will be mailed ___ I wish to pay over time -- 10% due now
(Please make check Payable to "Woodstock Institute for Negotiation")
Please Charge $________ to: __ VISA __ MasterCard __ American Express
Card Number: _______________________________________ Expires: ___ _____
Name as it appears on card: _____________________________________________
Signature: ___________________________________
Policies of the Woodstock Institute for Negotiation for this Program:
Early Registration: This discount of $50.00 is only available if full payment of the registration
fee is received by the Woodstock Institute for Negotiation on or before June 23, 2010. This discount is not available
if you choose to pay over time
Government/Non-Profit Employees: This discount of $300.00 is only available to full-time employees of a 1) a state,
county or local government entity; 2) a federal government entity; or 3) a Non-Profit organization which qualifies under
federal law as a 501(c)(3) tax-exempt charitable, educational or religious organization.
Multiple Employees: If multiple employees of the same company, organization, or state or federal agency register
for all five days of the same training program, then each of the employees shall be entitled to a discount of $50.00.
Payment over Time: Participants may elect to pay the fees for this program over time by ten equal monthly payments. Each payment
will be equal to ten percent of the total fees with the first payment due at the time of registration and each subsequent payment
due on the 1st of the month beginning on August 1, 2010 and ending on April 1, 2011. There is no interest charged for this election
provided all payments are received by the Woodstock Institute for Negotiation within 30 days of each due date. In the event
any payment is not received within 30 days of a due date, interest will be charged on the outstanding balance at the rate of 1% per month
(ANNUAL PERCENTAGE RATE = TWELVE PERCENT (12%) PER ANNUM)
Hotel Accommodations: Hotel accommodations are NOT included with your registration fee. You must make your own
reservations at the Courtyard by Marriott Hanover/Lebanon by calling them at 800 321-2211 or 603 643-5600.
Cancellation Policy: Up to 14 days prior to the beginning of the first session, you are allowed to cancel your
registration entitling you to a refund of your payment less a cancellation fee of $50.00. No refunds will be given
after this time, but you will be allowed to send a substitute person to the program you registered for OR you or your
substitute may attend a future Certificate Program for Negotiating, Collaborating and Leading in Today's World for a
re-registration fee of $100.00. If you attend the first session and are unable to attend the second session, you
may attend a future second session of the Certificate Program for Negotiating, Collaborating and Leading in Today's World
for a re-registration fee of $50.00.
If you are not able to print this Registration form, please send us an e-mail or call us and we will fax or mail the
Registration Form to you.
If you have any questions, please call us Toll Free at: 800 457-3211
May 26, 2010
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