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WIDP Basic & Advanced Seminars Registration

* An asterisk indicates a required field.

CONTACT INFORMATION
First Name*
Last Name*
Title
Organization
Mailing Address*
Address (cont.)
City*
State/Province*
Zip/Postal Code*
Country*
Work Phone*
Home Phone
FAX
E-mail*
URL

PAYMENT INFORMATION

Payment option*

Credit Card Information 
(Disregard if not paying with a credit card)

Name as it appears on your credit card
Expiration date (month/year)
Billing Address
Address (cont.)
Billing City
Billing State/Province
Billing Zip/Postal Code
Billing Country

CONFIRMATION

I am enrolling people in the WIDP (Note:  If you are enrolling anyone other than yourself, please note the names and addresses of the other attendees in the Comments section below.)

I understand that the fee of a seminar is $230 per person, or $130 for alumni.  The fee includes a snack Friday evening and lunch Saturday.  For anyone who does not already have a WIDP Profile, I understand I must also pay $40 to get my WIDP Profile.

By my signature below, I agree to allow Worley ID Profile to charge my credit card for the , unless I am paying by alternate means.  (Note:  If not paying with a credit card, please enclose a minimum deposit of $50 per person when you mail this form.)

PLEASE REVIEW THIS FORM CLOSELY FOR ERRORS BEFORE SIGNING.

 

Signature:  ________________________     Date:  _______

 

COMMENTS

Print, sign, date, and mail or fax this form to:

Worley's ID Profile
44 Farmers Row
Groton, MA 01450-1802
Tel: 978.448.2047
Fax: 978.448.3910

(For registration by credit card, you may opt to fax this form, rather than mailing it.)

NOTICE:  WE RESERVE THE RIGHT TO CANCEL ANY SEMINAR IF THERE ARE NOT A SUFFICIENT NUMBER OF REGISTRANTS.  IN SUCH CASES, A FULL REFUND WILL BE PROVIDED OF ALL DEPOSITS AND PAYMENTS FOR THE CANCELED SEMINAR.

After you have printed this form, click here for information regarding travel arrangements.


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