2016 Global Summit of Women

Registration Form

Registration Deadline:May 9, 2016

Registration is also available at

PLEASE PRINT OR TYPE (One Form Per Delegate):

LastName (Family Name): ______

(Print your family name as it should appear on your Summit badge)

FirstName: ______

Position: ______

Organization: ______

Mailing Address: ______

City: ______Country: ______Postal Code: ______

E-mail: ______Tel: ______Fax: ______

REGISTRATION FEE

Registration Fee includes the three-day conference, all meals from evening of June 9 to closing on June 11, transportation to any outside venue, simultaneous interpretation for all sessions, and all program materials.

Rate
Fee is in Euros (€) for those within Europe and US Dollar ($) for rest of the world
Non-Profit, Governmental, and Small Business Rate / 650
Business Rate (for Participants from Corporations) / 950
Spouse/Son/Daughter Rate (Includes Evening Events ONLY - Opening Ceremony/Dinner on June 9, Gala Dinner on June 10, and Closing Ceremony on June 11) / 350

METHOD OF PAYMENT

______Bank Check (in US dollars ONLY) made payable to: Global Summit of Women/WREI

______Credit Card

Cardholder Name: ______

Card Type: ______Account Number: ______Exp. Date: ______

Signature: ______

CANCELLATION POLICY: In the event that you must cancel your registration, notice of cancellation must be submitted in writing to before May 9, 2016 to receive a refund. There will be a 10% processing fee against the cost of the registration to cover extremely high banking fees for refunds. For cancellations received after May 9, no refund will be issued.


PROFESSIONAL PROFILE

Please circle one in each category:

Occupation:CorporateEntrepreneurGovernmentNGOAcademicOther

______

For Business Registrants Only:

Industry:Agriculture Business Services CommunicationsConstruction Consultancy Energy Financial Services Food/Beverage Health Care Info. Technology Manufacturing Media Mining Pharmaceuticals Retail Transportation Tourism Wholesale Other ______

SPECIAL SUMMIT SESSIONS

In order to reduce food waste, please indicate in which meal sessions you plan to participate

  • Welcoming Dinner onJune 9: YES / NO
  • Networking Breakfast onJune 10: YES / NO
  • Lunch onJune 10:YES / NO
  • Gala Dinner onJune 10:YES / NO
  • Networking Breakfast on June 11:YES / NO
  • Lunch on June 11:YES / NO
  • Closing Reception on June 11:YES / NO

Vegetarian?YES / NOSPECIAL DIETARY NEEDS: ______

SUMMIT HOTEL ACCOMMODATIONS


Hotel reservations are only possible with proof of Summit registration. Special hotel rates for Summit delegates are available at the Warsaw Hilton Hotel, the site of the 2016 Global Summit of Women. The rate for a King Hilton Guest Room is PLN 356.18 (tax included) (approx. US$94). Information on accessing the special rate will be sent to you following receipt of your Summit Registration Form.

PHOTO FOR REGISTRATION BADGE

Please attach a headshot photo of yourself to this registration form and send to . The photo will appear on your delegate badge.

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