Goldratt Institute - [TOC World 2001 - JEMBA Symposium Registration Form]

JEMBA 2001 Registration Form

** indicates required field
PROGRAM
(To register for TOC World^SM 2001, go to the TOC World^SM 2001 registration form)

ATTENDEE
**First Name:
**Last Name:
**Position:
**Email:
**Whom should we contact in case of emergency?
**Emergency Contact Telephone Number?



ORGANIZATION INFORMATION
**Company/University:
**Division/Department:
**Address:
Address:
**City:
**State/Province:
**Zip/Postal Code:
**Country:
**Phone:
Fax:
Registration Code:



ADDITIONAL MEMBERS FROM YOUR TEAM
#2 First Name:
#2 Last Name:
#2 Position:
#2 Division/Dept:
#2 Email:

#3 First Name:
#3 Last Name:
#3 Position:
#3 Division/Dept:
#3 Email:

#4 First Name:
#4 Last Name:
#4 Position:
#4 Division/Dept:
#4 Email:

#5 First Name:
#5 Last Name:
#5 Position:
#5 Division/Dept:
#5 Email:

#6 First Name:
#6 Last Name:
#6 Position:
#6 Division/Dept:
#6 Email:



PAYMENT INFORMATION
	The basic price of the 5-day JEMBA Symposium is $2000 USD per participant
	For two or more attendees from the same organization, the price is $1900 USD per person.
	For a company team comprising line and staff functions from the same organization, the price is $1800 USD per person.
	For a representative faculty from a school or university the price is $1800 USD per person.
	The price for university administrators is $1800 USD per administrator.



METHOD of PAYMENT
	PO#
	Visa
	MasterCard
	American Express
Card No.
Exp. Date:
***Total Paid:
Name on Card:



SPECIAL REQUIREMENTS
Check if you require a vegetarian meal for lunch.

If you are disabled and require special services, please provide a written description of your needs.

Signature_________________________________
(if printing and faxing)

Interested AGI Academic Associates, Academic Jonahs, masters or doctoral students, please contact Rika Visser at rika.visser@goldratt.com for futher information.

If arrangements for a payment schedule are desired, please contact Rika Visser at rika.visser@goldratt.com.

The symposium fee includes a daily continental breakfast, lunch, and morning and afternoon refreshments. Join us for the welcome reception on June 19th. Prices exclude travel and lodging.

Cancellation Policy
Cancellations must be submitted in writing and postmarked or faxed to 1-203-624-9607 at least ten business days before the event to receive a refund (minus a $75 cancellation fee). After this date, no refunds will be given. Refunds will be processed after the event. In case of cancellation, AGI does not accept responsibility for covering airfare, hotel or costs incurred by registrants. Program content subject to change without notice.