Application Form MYBP

Application Form: 4th Seminar

“Maximize Your Board’s Potential”, Cambridge, MA,
October 6-9, 2014

Name

*
Last Name *
First Name *as you would like it to appear on your badge
Title *
Date of Birth *dd-mm-yyyy

Private Address

Address
Zip Code
City
State/Country
Telephone
E-mail

Company details

Company Name *
Position *
Address *
Zip Code *
City
Business Telephone *
Business E-mail *
Business Fax

Preferences

Please invoice me to my: *
Private Address Company Address
Please send mail to my: *
Private Address Company Address
Please send e-mail to my: *
Private Address Company Address
Diet indication
Please provide a short description of your current position

Verification

Please enter any two digits with no spaces (Example: 12)*

Confirmation
After submitting the application form you will receive a personal e-mail to confirm your application.

Cancellation Policy

If you cancel less than 30 days before the start date of the program we will charge a cancellation fee equivalent
to the cost of the participation fee.

Changes in Program
The program and calendar dates are subject to change. Management reserves the right to change the program
without any prior notification, or cancel the program if the number of participants is deemed insufficient to proceed
effectively. A change in part(s) of the program does not entitle participants to any form of refunding.

Terms of Payment
After receipt of this application form we will send you an invoice.
Payment must be made within 14 days after receipt of invoice.

Liability
The total liability of The Decision Institute relating to any program shall in no event exceed the total program
fees The Decision Institute receives hereunder for the work giving rise to liability, or include any special,
consequential, incidental or exemplary damages or loss (nor any lost profits, savings or business opportunity).

Application Form MYBP

Name

Private Address

Company details

Preferences

Verification

Search

Programs

Contact

Websites

Agenda