Registration Form

A Non-Residential Group Relations Conference

Leadership, Complexity and Spirit
The Spiritus Mundi Conference

October 22-24, 2004

The James MacGregor Burns Academy of Leadership
University of Maryland
College Park, Maryland

Application for Membership and Conference Policies

 

* Title Dr. Ms. Mr.
Other
* Name
* Employer/ Org. Affiliation
Address
   
* City
* State
Zip
E-mail
Phone
The information marked with a * will be given to all members of the conference.
 
The information below will be for staff use only.
Work Role
Age
Gender
Race/Ethnicity
Other Identity
Group Relations Conference Experience? 0 1 2 3+
Name of associates atending this conference
 
Reference Letter Policy: Each applicant must provide a written letter of reference from someone, preferably in her/his organization, who can vouch for the applicant’s capacity to participate in an intense learning experience. It is the applicant’s responsibility to assure that this letter is submitted. The letter may be submitted by email to WBCFallConference@yahoo.com. A reference letter will be forwarded by:
Name
Phone/E-mail
 
Attendance Policy: Events begin and end promptly at the times designated. Because the conference is designed to be educational as a whole, not simply in parts, individuals who know in advance that they are unable to attend all sessions are discouraged from applying. 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.
 

Tuition for this Conference:
Tuition is $250.00
Full-time Students $100
Limited Scholarships are available.

For groups of 3 or more people, a special discount may be negotiated with the conference administrator.
 
Withdrawal policy: An administration fee of $50 will be retained if the application is withdrawn prior to or on October 1, 2004. After that date no refunds will be issued.
 
Payment
Enclosed check payable to Washington Baltimore Center, for $__________
  PayPal
I have read the brochure for this conference in detail and hereby apply for membership. I understand that my application authorizes the WBC and The Burns Academy of Leadership organization to conduct the conference in the manner described. My conference fee, deposit or voucher accompanies this application. I understand and agree to all policies stated on this application form.
Signature _____________________________
Date _____________________________
 

Instructions:
If you are going to fax or mail in your registration, then print this page
and fax it to the number below and click Proceed.
If you are going to register online, then click Proceed to continue
and use the secure transaction server at PayPal
to enter your credit card data.

 

Send this form with payment and all documentation to:

Leadership, Complexity and Spirit
11513 Canterbury Court
Bowie, MD 20721

Email WBCFallConference@yahoo.com
Phone 202-887-8955
Fax 301-405-6402

 
The Washington-Baltimore Center for the Study of Group Relations