Common Bond Institute
Email
Version of
REGISTRATION
FORM
(copy
and paste text into an Email to complete and return)
3rd
Annual International Conference on
"Religion, Conflict, and Peace:"
Walking The Talk To Compassion And Harmony
April
8-10, 2011
Location:
Henry Ford Community College,
Dearborn, MI
USA
Conference
Details at: www.cbiworld.org/Pages/Conferences_RCP.htm
~
Registration is Open to All ~
CONTACT INFORMATION: (Please include Email and Phone)
NAME: _______________________________________________________
ADDRESS: Street__________________________________________________
City_____________________________State________Zip Code_________
Country________________
PHONE _________________________ FAX_______________________
CELL ___________________________
EMAIL_______________________________________
WEB _______________________________________
* [ ] I do NOT wish to be included in conference roster distributed to participants (address, phone, & Email only)
REGISTRATION FEE: (See separate optional meal fees below)
1) CONFERENCE PROGRAM FEES (NOTE: see separate Meal fees below)
Reistration Fees:
[ ] $100 General
[ ] $ 90 Supporting Organization (with
proof of status)
[ ] $ 80 Co-Sponsoring Organization (with
proof of status)
[ ] $ 20 Full time Student
(with proof of status)
* HALF (1/2) Conference Registration - (1/2 the Regular Fee):
[ ] $ 75 Regular
[ ] $ 65 Supporting Organization (with
proof of status)
[ ] $ 55 Co-Sponsoring Organization (with
proof of status)
[ ] $ 10 Full time Student (with proof
of status)
* NOTE: HALF Conference Registrations are for EITHER:
Friday and Sunday -OR- Saturday and Sunday
Please indicate which days on "Comments"
line below
2) MEAL FEES: (separate optional fees)
Conference Community Lunch and Dinner (meals are halal):
Friday Lunch [
] $ 9 *($ 10 on-site)
Friday Dinner [
] $ 15 *($ 16 on-site)
Saturday Lunch [
] $ 9 *($ 10 on-site)
Saturday Dinner [
] $ 15 *($ 16 on-site)
Sunday Lunch [
] $ 9 *($ 10 on-site)
Dinner Diet Choice*: [ ] Vegetarian [ ] Poultry [ ] Meat
PLEASE NOTE: On-site meal purchase is very
limited.
We encourage you to
register for meals in advance.
SUMMARY OF CHARGES
Conference Fee __________
Friday Lunch __________
Friday Dinner __________
Saturday Lunch __________
Saturday Dinner __________
Sunday Lunch __________
Total Amount Due __________*
Amount Enclosed __________
* To choose payment by PayPal see button link on CBI website at: www.cbiworld.org/Pages/Conferences_RCP_Fees.htm
COMMENTS: _______________________________________
* For payment by PayPal see: cbiworld.org/Pages/Conferences_RCP_Fees.htm
METHODS of REGISTRATION and PAYMENT
(choose one):
(NOTE: registration is NOT confirmed until payment is received)
[ ] 1. On-line by Eventbrite and PayPal:
By Credit
Card or Checking account withdrawal (*see above link)
[ ] 2. By Email to: Common Bond Institute,
(by Check,
US Money Order, or Cashiers Check)
12170 S.
Pine Ayr Drive, Climax, Mich. 49034 USA
Phone/Fax:
269-665-9393
Email:
SOlweean@aol.com Web: www.cbiworld.org
* Note: Checks must be received
by April 1, 2011 for deposit
After
this date please use PayPal or pay on-site.
[ ] 3. By wire transfer (contact CBI for instructions)
[ ] 4. On-Site On-site registration opens Friday,
April 8 at 8:30 am
HOTEL: Special Hotel
room rate at: DoubleTree Hotel Detroit/Dearborn
5801 Southfield Expressway, Dearborn, Michigan 48228
(Telephone) 313-336-3340 (Fax) 313-583-1238
Hotel contact: Mimi Sion Mimi.Sion@hilton.com
$99 single/double - includes breakfast
______________________________________________________
Cancellations: $50 admin. fee for all cancellations up to 3-8-11.
No refunds can be made after 3-8-11.
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) .
Common Bond Institute
Steve Olweean, Conference Coordinator
12170 S. Pine Ayr Drive, Climax, MI 49034 USA
Ph/Fax: 269-665-9393 Email: SOlweean@aol.com
Website: www.cbiworld.org