Riet application form

COURSE REGISTRATION FORM

Rietveld Structure Refinement

(Theory and hands-on four days short course)
February 8-11, 2005 /

Name: Position/Title:

Company/Organization:

Address:

City: State: Zip code Country

Phone: ( ) Fax: ( )

Mobile No: Email:

Authorised by:

Position/Title: Email:

Note: Email addresses will be used for confirmation of your registration.

Please return your completed registration
form with payment to:
XRD.US
52 Papania Drive, Mahopac, NY 10541
Ph: (845) 661 1421 Fax: (845) 845 8461
Email: /
Tuition fees (per four-day course, including all materials and meals) for government and academy: USD 1860.00 and Industry: USD 3000.00 (Student discount 14% applicable),
should be paid by checks payable to Corpuscular Inc. The checks should be mailed to us before January 20, 2005
Total Payment: $
Please find my checks enclosed
Signature:

BOOKING AND CANCELLATION POLICY:

1.  Course numbers are limited to ensure maximum personal attention for all participants. Places are allocated in order of receipt of registration form.

2.  Written cancellation received up to fourteen days prior to the commencement of the course will attract an administration fee of $25 per person. Written advice should be directed to the XRD.US by fax.

3.  No refund can be made for cancellations received within thirteen days of commencement of the course.

4.  If no written cancellation is received prior to the course and the participant does not attend on the day(s), then the participant or the authorising company/organization are liable for full course fees.

5.  Should the participant be unable to attend, a substitute nomination is welcome at no additional charge.

6.  A transfer of course registration can be made at any time. Advice must be in writing and directed to the XRD.US. Each transfer will attract a $25 administration fee.

7.  We reserve the right to cancel/postpone a course in the event of unforeseen circumstances or insufficient numbers. Every effort will be made to ensure that participants of cancelled courses are placed on the next available course. Where a course is cancelled by the XRD.US and the participant elects not to be placed on the next available course a full refund will be made.

PRIVACY POLICY:

XRD.US Australia is committed to protecting your privacy and the confidentiality of information provided to us. The information you provide is necessary to enable the processing of your registration and updating your current records with us. The information will be used to contact you regarding registrations and cancellations, provide you with information about a range of current and future executive development opportunities and other prospective events that may be of interest to you.

Information provided by you may be disclosed to a relevant third party as a part of the registered training organisation quality audit requirements. Information may also be disclosed to our associates and related parties for the purposes of marketing professional development opportunities.

Participants may opt out of receiving marketing material by contacting the XRD.US and requesting to ‘unsubscribe’.

I do ¨, do not ¨ (please tick) give permission to the XRD.US to disclose any information provided by me on this form to any third party.

Registration Ends January 20, 2004

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