Registration Form

A Non-Residential Group Relations Conference in the
Tavistock Tradition

Authority, Leadership and Learning
in Organizational Life

April 2 – 4, 2004
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 used only to form homogenous
Role Analysis and Application Groups.
Work Role
Age
Gender
Race/Ethnicity
Other Identity
A. K. Rice/Tavistock Conference Experience? 0 1 2 3+
Name of associates attending this conference
 
Reference Letter Policy: Each applicant must provide a written letter of reference from someone, preferably from his/her 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 WBCLearning2004@aol.com. A reference letter will be forwarded by:
Name
Relationship
 
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 $175.00
For groups of 3 or more people, a special discount may be negotiated with the pre-conference administrator.
 
Withdrawal policy: An administration fee of $30 will be retained if the application is withdrawn prior to or on March 26th, 2004. No refunds will be issued after March 26th, 2004.
 
Payment
Enclosed check payable to Washington Baltimore Center, for $__________
  VISA MasterCard  
Name on Card ______________________________
Card # ______________________________
Exp. Date ______________________________
Amount $ ______________________________
Signature of cardholder ______________________________
I have read the brochure for this conference in detail and hereby apply for membership. I understand that this brochure constitutes the contract between me and Washington Baltimore Center and that my application authorizes the 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:

Authority, Leadership and Learning
504 Aspen Street NW
Washington DC 20012

Email WBCLearning2004@aol.com
Phone 202-291-6799
Fax 202-833-9177 (before March 25th, after this date please contact the pre-conference administrator for an alternate fax number)

 
The Washington-Baltimore Center for the Study of Group Relations