Interaction Institute for Social Change

Workshop Registration Form

Workshop Schedule | Registration Form | Workshop Logistics

All fields marked with an asterisk (*) are required.

Register for Facilitating Change (pick a different workshop)
*

First Name: Last Name: *
Title/Dept.: Organization: *
Address 1: * Address 2:
City: * State/Province: *
Zip code: - * Country: *
Email: * Phone: *
Website Address: Fax:

Dietary Restrictions:* No Yes
Food: Continental breakfast and lunch are served each day as well as afternoon snack.

How did you hear about this workshop?

IISC Contact Community Event
Brochure In-house Workshop Attendees
Referral Public Workshop Attendee
Postcard or Mailing Email
Web Other

Registration Policies:

Payment in full is required prior to the workshop. We accept personal or company checks and purchase orders. We also accept MasterCard, Visa and American Express credit cards.

Cancellations received fewer than ten business days prior to the workshop date are subject to the full fee. Transfers to another course fewer than ten business days before the workshop will incur a charge of 25% of the tuition.

Please note that no more than four people from one organization may participate in the same workshop. We regret any inconvenience this may cause and invite you to contact us to discuss the possibility of arranging for an IISC workshop at your location.

Please see the workshop logistics page for more important information about our workshops.

If you have any special requests or comments regarding your registration, please enter them here.

Please select a payment method:*

Credit card

Mail a Check

Purchase Order Purchase Order #:

Please select a rate based on your organizational affiliation:*

Nonprofit Organization Rate: $650

Foundation Rate: $1,000

I have read the terms and conditions of registration, and I am now ready to submit my registration form.