Registration Form

A Non-Residential Group Relations Conference in the
Tavistock Tradition

Authority, Leadership, Integrety and Learning
in Organizational Life

April 1-3, 2005
University of Maryland
College Park, Maryland


Application for Membership and Conference Policies

Deadline for all materials: March 28th, 2005

 

* 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 LearningConf05@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.
 
Conference Fees
Conference Fee: $300.00
 
Employees of non-profit agencies, government, students (with current ID), school teachers and administrators, and two or more individuals attending from the same organizations are entitled to a discounted fee of $150 per member. Af few scholarships may be available
 
Non-profit Organization
Employee		 $150.00
Please specify Organization
Students $150.00
Enlose copy of your Student ID
School Teachers $150.00
School Administrators $150.00
Groups of 2 or more $150.00
For individuals attending with two or more from the same organization, please list others names
 
Withdrawal policy: An administration fee of $30 will be retained if the application is withdrawn prior to or on March 25th, 2005. No refunds will be issued after March 25th, 2005.
 
Payment
Enclosed check payable to Washington Baltimore Center, for $__________
  VISA MasterCard  
Name on Card ______________________________
Card # ______________________________
Exp. Date ______________________________
Amount $ ______________________________
Signature of cardholder ______________________________
Please check this box if you would be interested in attending a five-hour post-conference application workshop for a fee of $75.00. The location, time and date of the workshop is to be determined however it will be conducted in the Baltimore, MD—Washington, DC metropolitan area and occur in July 2005. You will be notified by April 25th, 2005, about this workshop if a significant number of conference participants express interest. This is to determine interest only, please do not include this fee as part of your conference fee.
 
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___________
 

Please click 'Proceed' to e-mail your info,
then print this page to fax or mail to conference organizer.

 

Send this form with payment and all documentation to:

Authority, Leadership, Learning and Integrity
1520 Corcoran Street NW
Washington DC 20009

Fax 202-429-0102 (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