Churchill perspectives on leadership 30th INTERNATIONAL CHURCHILL CONFERENCE - OCTOBER 31 - NOVEMBER 2, 2013
Registration FORM NAME(S):____________________________________________________________________________________________ ADDRESS:_ __________________________________________________________________________________________ CITY:_____________________________STATE/PROV:________ ZIP/POSTAL CODE:_____________ COUNTRY:_ ______________ PHONE: _______________________________________ EMAIL ADDRESS:__________________________________________ PREFERRED NAME(S) FOR YOUR BADGE(S): (1) _______________________ (2) ________________________ FIRST TIME ATTENDEE?
YES _____
NO _____
All prices quoted in U.S. dollars and are per person, unless otherwise noted. Spouses or partners are considered members for registration purposes. Tax deduction shown is amount allowed for U.S. registrants. □
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Chartwell Club Package (US Tax deduction: $1,103 couple/$442 single) $3,000 couple Includes Welcome Reception, 2 luncheons, Special VIP $1,500 single Reception, Friday and Saturday dinners with special seating, tickets for two optional tours and student underwriting. Blenheim Club Package (US Tax deduction: $940 couple /$360 single) $2,500 couple Includes Welcome Reception, 2 luncheons, Saturday Gala $1,250 single Dinner, tickets for two optional tours and student underwriting. Following are Individual Ticket Prices if Purchased Separately Basic Registration – Member $475.00
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Basic Registration – Non-member (Includes one year membership)
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Special Teacher Registration – Teachers at secondary, high school or college level; includes all sessions and luncheons.
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[__] Person(s)
$________
[__] Person(s)
$________
[__] Person(s)
$________
$600.00
[__] Person(s)
$________
$100.00
[__] Person(s)
$________
Friday Dinner and Reception (cash bar) $145.00 [__] Person(s) Saturday Black-tie Gala Dinner and Reception $195.00 [__] Person(s) National Cryptologic Museum Tour (Thursday) $90.00 [__] Person(s) Dodona Manor Tour (Thursday) $70.00 [__] Person(s) Washington By Night Tour (Thursday evening after reception) $40.00 [__] Person(s) Following are Single-Day Tickets for Locals Unable to Register for Whole Conference Thursday (Includes evening Welcome Reception) $75.00 [__] Person(s) Friday sessions (Includes Luncheon, but not dinner) $225.00 [__] Person(s) Saturday sessions (Includes Luncheon, but not dinner) $225.00 [__] Person(s)
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Total Amount Due:
$________ $________ $________ $________
For late registration (after October 1), please add $50 per registrant. Checks should be made payable to “The Churchill Centre” and sent with this form to the address below, or FAX or phone Visa/MasterCard/Discover/American Express information: Card Number: ________________________________________Exp. Date:____________________ CVS Code_________________________ Authorized Signature: _ ___________________________ Print name exactly as it appears on the card:_ _________________________________ If your credit card billing address is different from the address on top of registration form, please include billing address here:________________________ ____________________________________________________________________________________________________________ PLEASE NOTE: You may also register online by going to the secure server at http://bit.ly/14Hiaf1.
THE CHURCHILL CENTRE
P.O. Box 945, Downers Grove, IL 60515-0945 Toll Free: 888-WSC-1874 • Local Phone: 630-512-9341 • FAX: 630-515-1123 WWW.WINSTONCHURCHILL.ORG