Facilitating Online Interaction Registration for May 2007 Workshop

1. Workshop Information

To register please fill out and submit the form below. If you are choosing to pay by wire transfer or sending a check, Nancy will send you the details after you register.

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* 1. Registration Agreement:

I want to register for the Facilitating Online Interaction workshop that starts May 7th, 2007. My contact and payment information are detailed below. By returning this form, I understand and agree to the following conditions.

I understand that full tuition of USD $750,00 is due at least 3 days prior to the start of the class.

I understand that this workshop is held fully online and that in addition to the asynchronous work, there are two or more optional 1-hour teleconference calls for which participants are responsible for all long distance charges. (There will be a Skype or similar option.)

I understand that checks returned due to nonsufficient funds will be charged a $50.00 USD fee.

I have read and agree to the following cancellation policy:
Cancellation Policy:

A) Cancellation up to 7 days prior to start of course, full refund less $50 administration fee.
B) Cancellation within 7 days of start of course, registration fee may be transferred to another course or individual.

I agree

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* 2. Your Contact Information

Name

Street Address 1

Street Address 2 (if needed)

City

State or Province

Zip or Country Code

Country

Telephone (with country code)

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* 3. plan to pay by...

Check in US Dollars

Wire transfer in US Dollars

I have been offered a scholarship

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* 4. If you need a receipt, please note here. If you require a special code or number on your invoice, please email it to Nancy

Yes

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* 5. I will be paying

$750.00 - normal individual rate

$675.00 - discount rate (10% discount for groups of 5 or more or members of 501(C)3 non profit or international NGO organizations.)

$675.00 - friends of alumni rate - please list the alumni in the next question

$600.00 NCDD Member rate (special rate for NCDD members)

$0.00 - I have a confirmed scholarship (Please do not use this option unless you have received confirmation from Nancy White that you have a scholarship)

Facilitating Online Interaction Registration for May 2007 Workshop

1. Workshop Information

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* 2. Your Contact Information

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* 3. plan to pay by...

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* 4. If you need a receipt, please note here. If you require a special code or number on your invoice, please email it to Nancy

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* 5. I will be paying

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* 6. I am registering as a "friend of a workshop alumni." Their name is

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* 7. How did you hear about the workshop?

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* 8. Any special requests or other information you would like me to know?