Partners Leading Change Registration - (Invoicing Option)

Partners Leading Change Registration – (Invoicing Option)

Registration for Partners Leading Change

Date: Sept. 21 -22 (classroom sessions) and Tuesdays, Oct. 11 and 18, 2016, 3-5 EDT/12-2 PDT (video conference sessions). Complete details and logistics Location: Acqua Hotel Mill Valley, just north of San Francisco

Cost: $4,500 USD per person

Note: Course requires a minimum of 20 participants
in pairs of one male and one female executive from the same company
(although not necessarily working together),
maximum is 28 participants (that is, 14 pairs)

Pairs should register individually

This registration form can be submitted for participants wishing to have
their company invoiced for the cost of tuition.

Registration Form

* indicates required field

First Name:*

Last Name:*

City of Residence:

Cell Phone:*

Work Phone:*

Work Fax:

Personal Email*

Work Email:*

Assistant's Name:

Assistant's Phone:

Assistant's Email Address:

Your Title:*

Your Company:*

Mailing Address - Street:*

City:*

State:*

Zip:*

Exact name you want printed on your name tag & other materials:*

I will be attending with the following partner

Partner's Name:*

Partner's Job Title:*

Partner's Company:*

Note: Your partner for the course needs to register separately.

FOR INVOICING PLEASE COMPLETE THE FOLLOWING FIELDS:

Name of person to invoice:

Title:

Company Name:

Email Address:

Work Phone Number:

Cell Phone Number:

Mailing Address:

Invoicing & Payment
Invoices are issued upon receipt of this Enrollment Agreement. Payment must be received 30 days from the date of invoice, or upon registration if less than 30 days before the program's scheduled start date. If payment is not received, we reserve the right to cancel the registration and charge a cancellation fee.

Cancellations and Transfers:
Before a program begins, IWL incurs substantial administrative costs related to your registration. Please read about our Cancellation and Transfer Policy below, prior to registering.

Both IWL and participants put much preparation into a program before it begins. Because of this, we encourage you to try your best to attend the program for which you have registered. If you are unable to attend your program, you may choose one of the options below, where the following fees apply:

* For transfers occurring five to eight weeks from the program start date: Fees may be waived if the registered participant immediately selects a new program date.

* Transfer to another program date. Transfers occurring eight weeks prior to the program will incur an administrative fee of 10% of the full program fee. Within four weeks of the program, 25% of the full program fee will be charged. Within two weeks of the program, 50 % of the program fee will be charged.

* Provide a substitute. All fees are waived if your company arranges for a substitute participant who meets program criteria, can complete all the necessary pre-course work and can attend on your original program date. Because of the time needed to process pre-course work, substitutions cannot be made within two weeks of the program date. Please be aware that substitute participants will be required to do a very quick turnaround on pre-course work for a program.

• Cancel your registration. Registrations cancelled five to eight weeks prior to the starting date of the program will incur a penalty of 50% of the full program fee. Within four weeks of the program, 75 % of the full program fee will be charged. Within three weeks of the program, 100 % of the full program fee will be charged. Please Note: If you cancel your registration, any pre-course materials that we may have developed with you will be purged from our system. We will need updated pre-course work from you, should you decide to re-register at a later date.

Thank you for your interest in our work, and we look forward to an empowering partnership with you.

Yes, I understand and agree to the Terms & Conditions stated above:*

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Registration for Partners Leading Change