Registration Form

Deadline for Registration extended to May 7th


May 16th - 18th, 2008 Howard University Washington, D.C.

Title * Dr.   Ms.   Mr.   Other
First Name *
Last Name *
Address
City *
State *
Zip code
E-mail
Phone
Employer/Org.Affiliation *
The information marked with a * will be given to all members of the conference

The information below will be used only to inform the work of staff and to aid in forming some conference work groups
Age
Gender
Race/Ethnicity
Nationality
Sexual Orientation
Work Role
Previous Group Relations Conference Experience none   1   2   3 or more
Other Differences and/or Aspects of Identity
Reference Letter Policy: Each applicant must provide a written letter of reference from someone, preferably in her/his organization, who can confirm the applicant's capacity to participate in an intense learning experience. It is the applicant's responsibility to assure that this letter is submitted by May 1, 2008. The letter may be submitted by email to DivConf08@gmail.com. A reference letter will be forwarded by:
Name
Phone/E-mail

Attendance Policy: Individuals who know in advance that they are unable to attend all sessions are discouraged from applying because the conference events are connected and together create the temporary institution. Also, because experiential learning events of this kind may be stressful, individuals who are ill or experiencing a period of personal difficulty may wish to forgo attendance at this time.

Conference Fees

$395, if postmarked on or before April 18, 2008
$425, if postmarked after April 18, 2008 and by May 1, 2008
After May 1, please contact the Administrator directly.

Discounts

The total discount amount cannot exceed $75.00.
$50 discount for two or more persons applying as a group from the same institution
$50 discount for members of A.K. Rice Institute for the Study of Social Systems
$50 discount for full-time students (submit copy of current student ID)

Scholarship Opportunity

A generous donor has offered some scholarship funds in memory and honor of Lamis K. Jarrar, Ph.D., to support attendance at this conference. The scholarship is available to Arab women of any nationality, with preference given to Palestinian Arab women. Scholarship funds may be used toward conference fees, transportation, lodging and/or meal costs. If you are interested in applying, please send a letter of application along with your completed registration to the Conference Administrator. Your letter should include information about how you meet the criteria and your interest in attending this conference. Additionally, please indicate the amount, up to $600, you are applying for. The deadline for scholarship applications is April 18th , 2008. If you have any questions, please contact the Administrator.

Deposits

$75 non-refundable deposit reserves a place at the conference (balance due by May 1, 2008)
$75 deposit with letter requesting reduction of conference fees (Letter must by received/postmarked by May 1; letter may be submitted by email to DivConf08@gmail.com)
No deposit

Total fees/deposits:       Balance:

Withdrawal policy: An administrative fee of $75 will be retained if the application is withdrawn prior to or on May 1, 2008. No refunds will be issued after this date.

Make check payable to WBC

I have read the description of this learning event in detail and hereby apply for membership. I understand that this brochure constitutes a contract between the Washington Baltimore Center and me; my application authorizes the organization to conduct the conference in the manner described in the conference brochure. My entire fee or deposit accompanies this application. I understand and agree to all policies stated on this application form.

Signature:

____________________________________________

Date: ____/____/________

Those who register on line will be asked to sign this agreement statement at the conference.

Instructions for submitting completed application

You may submit this form with payment and all documentation to:

Nathan McCray, Adminstrator
Politics of Power Conference
Burns Academy of Leadership
1119 Taliaferro Hall
University of MD
College Park, MD 20742-7715

DivConf08@gmail.com
(301) 405-7978