East Side Institute
an international research, education and training center for human development and community.
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East Side Institute
an international research, education and training center for human development and community.
Performing the World 2010
To register for Performing the World, please complete the form below.
Personal Information
First/Given Name
Last/Family Name
Gender
Male
Female
Street Address
City
State/Province/Region
Zip/Postal Code
Country
Email
Telephone numbers (Please include country and city codes.)
Work Phone
Home Phone
Mobile Phone
Fax
Institutional Affiliation and title (if any)
Occupation/areas of interest
College or University if you are a student
Is a Visa required for you to enter the USA?
Yes
No
If you answered yes, please answer the questions below:
Name exactly as it appears on your passport
Passport #
Date of Birth
Payment Information
Registration up to and including July 1, 2010 is $215. Registration after that date is $245.
Choose
Before July 1, 2010 ($
215
)
After July 1, 2010 ($
245
)
Total : $
0
If you prefer to pay by check or money order, please make payable to the East Side Institute and mail to: 104-106 South Oxford Street, Brooklyn, New York 11217
In the event that you need to cancel, please note the following policy:
Before July 1, full refund
Before August 1, 50% refund
Before September 1, 25% refund
After September 1, no refund
Type the words you see and submit.
*