Global Community Dialogue

GCD RegistrationForm

Dialogue # 12–Morada do Sol (Cascais, Lisboa)PT)

Sep 15 –Sep 19, 2017

Please fill out and sign the form below, and return it to us by e-mail () as soon as possible!

Registrations are due by July 10, 2017.

YES! Please register me for the 12th Global Community Dialogue in Lisbon!

Name
Company
Address
Telephone / E-Mail
Attending* / Sep 15 (6pm)
( ) / Sep 16
( ) / Sep 17
( ) / Sep 18
( ) / Sep 19 (10am)
( )
Signature

* Please tick the box (or replace it with an X) under all dates that apply; this information is for logistical purposes only

☐ Please tick this box if your address has changed or if this is the first time you are registering for the GCD/GDD.

Please indicate your participation level below:

ResidentialNon-Residential

SingleDouble

Student / Non-Profit / Unemployed €700€ 420€140

Individual (self-paying) €840€ 560€280

Employer-sponsored€910€ 630€350

Registration fees are required to confirm your registration, and include participation in the Dialogue as well as all meals and refreshments during the Dialogue (6:00pm CET Sep. 15, 2017 - 10:00amCETSep. 19, 2017). Fees are non-refundable after July10, 2017.

To make international (and/or credit card) payments, please visit and click on the "send payments" tab/link.Please enter s the email address to which you want to send funds (in Euros, please), and follow the directions from there.Please note that PayPal charges us 2.9% for such transfers, so if you can choose a bank transfer option, or via your own PayPal account, this would be preferable!

To make wire / bank transfersfor your GCD fees, please enter the following information in the transfer form:

Account Owner: Michael Hardtmann - GCD

Address: Formbachstr. 267 - D-64385 Reichelsheim - GERMANY

Bank: Sparkasse Odenwaldkreis - Heidelbergerstr. 2 - D-64385 Reichelsheim - GERMANY

IBAN: DE54 508519520 180105157 SWIFT: HELA DE F1 ERB

Bankleitzahl (Routing Number): 508 519 52 / Account: 180 105 157

OR

Account Owner: Michael Hardtmann - GCD

Address: Formbachstr. 267 - D-64385 Reichelsheim - GERMANY

Bank: Fidelity Brokerage Services - One Chase Manhattan Plaza, New York, NY 10005

Routing Nr. 101205681

Checking Acct Nr.:7710742321478

ACCT: z42-321478

Wire instructions:

J.P. Morgan Chase

Routing number:021000021

For credit to:National Financial Services LLC

Account number: 066196-221

For the benefit of: Michael Hardtmann

For final credit to: z42-321478

Address: One Chase Manhattan Plaza,New York, NY 10005

HOTEL REGISTRATION

The Morada do Sol, our exclusive location for this GCD has asked participants to fill out their guest registration from in advance, to facilitate our arrival and check-in. Please navigate to the link below, and fill out all fields on the form before submitting it!

Many thanks!

Please return by e-mail () or post before July 10, 2017!