Registration Form for WIN Caucus
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Registration Form for
WIN Caucus
May 4-5, 2010
Best Western Silver Fox Inn, Waterville Valley, New Hampshire
Please print this 2-page form, fill out the Registration Form, and Fax it to: 802 457-1501
OR Mail it to: Woodstock Institute for Negotiation, Pomfret Stage Road-Drawer 29, Woodstock, Vermont 05091. Please do not
send this form via e-mail if you are paying by credit card as your information will not be secure.
Name: _____________________________________________ I go by (for Name Tag): __________________
Company/Organization: ________________________________________ Position: ____________________
Street Address: ______________________________________________________________________________
______________________________________________________________________________
City: _____________________________________________ State: _______________ ZIP: ______________
Work Phone:____ _________ Home Phone:____ _________ Fax:____ _________ Cell:____ _________
E-Mail Address: ____________________________________________________________________
Previous WIN Training: ___________________________________________ Dates: ___________________
Fees:
___ May 4-5, 2010 $ 795.00 $_________
Includes copy of latest WIN Workbook
___ Set of WIN Reminder Cards with holder $ 25.00 $_________
___ Taking of 2 Conflict Behavior Surveys $ 50.00 $_________
___ Late Fee if WIN receives payment after April 26, 2010 $ 50.00 $________
Sub-Total $_________
Less Discounts:
___ Early Registration and payment by April 2, 2010 -$ 50.00 $_________
___ Multiple Employees Registering for same program -$ 50.00 $_________
___ Government & Non-Profit Full-Time Employee -$ 150.00 $_________
Total Amount Due $_________
Payment:
___ Payment Enclosed ___ Payment will be mailed
(Please make check Payable to "Woodstock Institute for Negotiation")
Please Charge $________ to: __ VISA __ MasterCard __ American Express
Card Number: _______________________________________ Expires: ___ _____
Name as it appears on card: _____________________________________________
Signature: ___________________________________
Policies of the Woodstock Institute for Negotiation for this Program:
Early Registration: This discount of $50.00 is only available if full payment of the registration
fee is received by the Woodstock Institute for Negotiation on or before April 2, 2010.
Government/Non-Profit Employees: This discount of $150.00 is only available to full-time employees of a 1) a state,
county or local government entity; 2) a federal government entity; or 3) a Non-Profit organization which qualifies under
federal law as a 501(c)(3) tax-exempt charitable, educational or religious organization.
Multiple Employees: If multiple employees of the same company, organization, or state or federal agency register
for the same program, then each of the employees shall be entitled to a discount of $50.00.
Hotel Accommodations: Hotel accommodations are NOT included with your registration fee. You must make your own
reservations with Best Western Silver Fox Inn by calling them toll-free at 888 236-3699.
Cancellation Policy: Up to 14 days prior to the beginning of the first session, you are allowed to cancel your
registration entitling you to a refund of your payment less a cancellation fee of $50.00. No refunds will be given
after this time, but you will be allowed to send a qualified substitute person to the program you registered for OR you or your
qualified substitute may attend a future WIN Caucus for a re-registration fee of $50.00.
If you are not able to print this Registration form, please send us an e-mail or call us and we will fax or mail the
Registration Form to you.
If you have any questions, please call us Toll Free at: 800 457-3211
March 4, 2010
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