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Common Bond Institute

4th Annual International Conference on
"ENGAGING THE OTHER:" The Power of Compassion

November 12-15 2009    Site: San Francisco, California, USA

REGISTRATION FORM
(Please PRINT CLEARLY, and include Email and Phone)

CONTACT INFORMATION:

NAME: ________________________________________________________

ADDRESS: Street _______________________________________________

City____________________________ State________Zip Code___________Country_________

PHONE ________________________ FAX____________________ CELL_________________

EMAIL____________________________________ WEBSITE ___________________________

[ ] I do not wish to be included in conference roster distributed to participants (address, phone, & Email only)

REGISTRATION FEES: (See separate meal fees below)

1) CONFERENCE PROGRAM FEES:

Registration: (After 11-1-09 fee increases)
   [  ]  $350  General
   [  ]  $320  Supporting Organization Member (with proof)
   [  ]  $290  Sponsoring Organization Member (with proof)
   [  ]  $175  Full time Student (with proof of status)

* HALF (1/2) Conference Registration: (After 11-1-09 add $10)
   [  ]  $175 General
   [  ]  $160  Supporting Organization Member (with proof)
   [  ]  $145  Sponsoring Organization Member (with proof)
   [  ]  $ 88  Full time Student (with proof of status)

* NOTE: HALF Conference Registrations are for EITHER:
     Thursday and Friday -OR- Saturday and Sunday
     If Half Conf., must choose: [ ] Thur-Fri  -OR-  [ ] Sat-Sun
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2) MEALS FEES:
Meal fees are inclusive of all taxes and service fees (Breakfast is on your own. The Hotel offers breakfast options or room service.
Note: Purchase of meals on-site is limited and on an "as-available-basis" only)
   Friday Lunch:      [ ] $24
   Friday Dinner:     [ ] $35
   Saturday Lunch:  [ ] $24
   Saturday Dinner: [ ] $35
   Sunday Lunch:    [ ] $24

Diet Choice:  [  ] Poultry   [  ] Vegetarian
  (Please choose one diet plan)

SUMMARY OF CHARGES
   Conference Fee      __________
   Friday Lunch          __________
   Friday Dinner         __________
   Saturday Lunch      __________
   Saturday Dinner     __________
   Sunday Lunch         __________

   Total Amount Due  __________
   Amount Enclosed    __________

** For payment by PayPal see: cbiworld.org/Pages/Conferences_ETO_Fees.htm

CEC: [ ] I plan to register for Continuing Education Credits on-site (processing fee to be paid on site)

Comments: ______________________________________________

METHODS OF REGISTRATION and PAYMENT with this firm: (Submit this form by Email or fax) **
1. Register: Submit this Registration form by by Email or fax
2. Payment:
     [a] On-line by PayPal: by Credit Card or Checking account withdrawal
            (*see above link for details)
     [b] By check, money order, cashiers check, or travelers check to:
            Common Bond Institute,
            12170 S. Pine Ayr Drive, Climax, Mich. 49034 USA
            Ph/Fax: 269-665-9393  Email: SOlweean@aol.com
            Web: www.cbiworld.org
     [c] By wire transfer (contact CBI for wire instructions)
     [d] On-Site in cash, travelers check, money order, or cashiers check
            (note late registration fee apply).
            On-site registration opens Thursday, Nov.12 at 4:00 pm

HOTEL ROOM RESERVATIONS: - Please register early -
Room reservations are made directly with the San Mateo Marriott Hotel in San Mateo, California (the conference site)
Special ETO Conference Room rate is $ 115 for single or double Rooms availability and discounted rate are time limited. After 10-22-09 guaranteed discount and availability is at the discretion of the hotel.
    San Mateo Marriott Hotel
    1770 South Amphlett Blvd., San Mateo, CA 94402
    Telephone: 800-229-9290
(See CBI website for full details on special room rates, travel to the hotel site, and direct link to hotel reservation website at: www.cbiworld.org/Pages/Conferences_ETO_SiteTravel.htm ).
[ ] I plan to register for a hotel room (to help us maintain room availability, please indicate your intention)
_____________________________________________________
Cancellations: $75 admin. fee for all cancellations up to 9-25-09.
                        No refunds can be made after 9-25-09.
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 by phone or in writing directly to Common Bond Institute).