Convention Registration Form(Please Print)

Name:

Title Last First MI

Spouse:

Children & Age:

Address:

City: State: Zip: Country: Cell#:

E-mail: Phone: Fax:

Registration Category (check all that apply) Check Donor Category benefits before entering the amounts

Number of Attendees / Early Early Bird
Cut off Date / Early Bird
Cut off Date / Standard
Cut off Date / Late
Cutoff Date / On site / Total
Mar.15, 2008
(12 mid night, PST) / May4, 2008
(12 mid night, PST) / Aug3, 2008
(12 mid night,PST) / Aug. 25, 2008
(12 mid night, PST) / Aug. 29-31, 2008
( ) Adults (Per Person) / $175.00 / $200.00 / $225.00 / $245.00 / $275.00
( ) Children (7 – 18 Yrs)+ / $50.00 Discount off of Adult prices above
( ) Continuing Medical~
Education (8 Hrs.) / $100.00 / $100.00 / $110.00 / $110.00 / $125.00
( ) Indian Registrants* / Flat Rate of $175.00 or Rs.7,000.00
( ) Students on F1 Visa^ / Flat Rate of $150.00
( ) Business Forum~ / $100.00 / $100.00 / $100.00 / $100.00 / $100.00
Donors (Donations may be Tax deductible)
( ) Kannada Mitra / Complimentary registration for 2 / $600.00
( ) Kannada Datha / Complimentary registration for 4 / $1,100.00
( ) Kannada Kanda / Complimentary registration for 4 and Free Half page B/W ad in Souvenir / $1,500.00
( ) Kannada Rakshaka / Complimentary registration for 4; 1 Free Business Forum Ticket; Free Half Page B/W advertisement in Souvenir / $2,100.00
( ) Kannada Bandhu / Complimentary registration for 4; 1 Free Business Forum Ticket;Complimentary One room for 3 nights; Free FullPage B/W advertisement in Souvenir / $3,000.00
( ) Kannada Premi / Complimentary registration for 4;2 Free Business Forum Tickets or 2 Free CME Tickets;Complimentary One room for 3 nights; Free FullPage Color advertisement in Souvenir; Stage Recognition / $5,000.00
( ) Kannada Kasturi / Complimentary registration for 4;2 Free Business Forum Ticket; 2 Free CME Tickets; Complimentary One Family Suite for 3 nights;Free Full Page Color advertisement in Souvenir;Limo transportation to and from airport; Stage Recognition / $10,000.00
( ) AKKA Membership / Become AKKA Member now (see below for details)
Grand Total ($)

+Age-appropriate baby sitting facility available for a standard fee. * Proof of current residency in India is required.

~ Convention Registration is a requirement. ^ Proof of F1 Visa number and Student ID number required.

Registration for WKC-2008 includes – Food, Admission to Conference, Souvenir.
Food Preference: Circle the Number: 1 2 3 4 5 Vegetarian ; 1 2 3 4 5 Non-Vegetarian
AKKA MEMBERSHIP DETAILS

2 Yr Membership Family $50 Individual $25

Life Membership Family $250 Individual $200
Hotel Booking Information: Please make your own reservation
CrownePlazaChicago O’Hare
5440 N. River Road
Rosemont, IL, 60018
Phone: 866-242-1055 / (limited # of Rooms held until August 14, 2008}
$109+Tax per room night
Group Code: AKA
Website:
DoubleTree Hotel O’Hare Airport - Rosemont
5460 N. River Road
RosemontIL, 60018
Phone: 847-292-9100 / (limited # of Rooms held until August 7, 2008}
$109 + Tax per room night { SOLD OUT AT DISCOUNT PRICE }
Group Code: AKK
Website:
Other Benefits: Hospitality Committee Chair:
Ravi Harsoor: 630-229-5701,
Payment Method
Registration Mailing address:
AKKA WKC 2008
319 N. Weber Rd.
PMB #411
Bolingbrook, IL60490
FAX Registration to:
(267) 960-5427
Attn: AKKA WKC 2008
Web Registration:

Contact Information:
Mr. Narendra Lingegowda
(847) 907-4647
/ By Check: Payable to: “AKKA-WKC 2008Conference”
By Credit Card: Card Type: Visa MC Amex Discover
Card Holder Name: ______
Card Holder Address (If different): ______
______
Credit Card Number: ______
Exp Date: ______
Amount Authorized: $______
Signature: ______
Date: ______
Cancellation Policy:
Registrations are Non Transferable
70% Refund if cancelled before June30, 2008
50% Refund if cancelled after June30, 2008 – before July 31, 2008
0 % Refund if cancelled after July 31, 2008

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