Group Registration Form

Page 1 of 4
Group Registration Form
Any organization registering a group of at least 3 individuals to a specific SeminarsWorld® location is eligible to send an additional registrant to a seminar at
that location at no cost.
The maximum number that any organization can receive is three complimentary registrations (one for every 3 registrants up to 9). This offer does not include
travel or hotel expenses. All registration forms must be submitted together via fax or postal mail to PMI Registration. No online registrations will be accepted
for group discounts.
Discounts are available for paid-in-full registrations only, and cannot be combined with any other discount(s). Complimentary registration must be requested
at time of enrollment and cannot be applied retroactively. Complimentary registration will be on lowest priced seminar.
COMPANY INFORMATION
The information requested below will be used to mail your seminar registration
confirmation (if e-mail is not provided). Please print legibly.
Company/ Organization
Street Address
City
State/Province
Primary Phone
Postal Code
URL
What is the organization’s primary business activity (industry)?
CONSTRUCTION
(002) Commercial/Heavy Industrial
(001) Residential
(003) Other________________
RESOURCES
(023) Agriculture
(027) Coal/Gas/Oil
(025) Ferrous Mining
(024) Forestry
(026) Non-Ferrous Mining
MANUFACTURING
(028) Automotive
(029) Chemical
(030) Concrete/Clay/Glass/Stone
(031) Electrical/Electronic
(032) Food
(033) Machinery/Metals
(034) Paper
(035) Petroleum
(040) Pharmaceutical
(036) Plastics
(037) Textiles/Fabrics
(038) Wood
(039) Other________________
OTHER BUSINESS ACTIVITIES
(045) Academia
(004) Aerospace
(005) Architectural Design
(006) Arts/Entertainment/Broadcasting
(046) Automation Systems
(007) Business Mgmt Svcs./ Mgmt Consulting
(053) City Management
(008) Computers/Software/DP
(044) Consulting
(009) Defense
(048) E-business
(010) Economics/Finance
(011) Education/Training
(041) Engineering
(012) Environmental/Waste/Sewage
(042) Financial Services
(013) Health/Human/Social Services
(043) Information Technology
(051) International Development
(014) Legal
(015) Printing/Publishing
(016) Public Administration/Government
(017) Real Estate/Insurance
(018) Recreation
(050) Supply Chain
(049) Systems Security
(019) Telecommunications
(020) Transportation
(052) Urban Development
(021) Utilities
(047) Web Technology
(022) Other________________
How did you learn about SeminarsWorld?
(01) Colleague/Friend
(02) Employer/Management
(03) PMI Component Organization
(04) Project Management Journal® / PM Network®/PMI Today®
(05) Advertising/Publicity
(06) Conference or Trade Show
(07) PMI website
(08) SeminarsWorld Instructor
(09) PMI Electronic Communications/E-mails
(10) Direct mail (brochure, postcard, catalog)
(11) Other (please specify)
Country
Page 2 of 4
Group Registration Form
ATTENDEE INFORMATION & SEMINAR SELECTION
Please complete one section for each attendee. If you wish to select more than one seminar per attendee (for example (2) One Day
Seminars), write the quantity next to the rate and the name of both seminars and their location(s) where designated.
Prefix
Mr.
Mrs.
Ms.
Dr. PMI Credentials
CAPM®
PMI Member
Yes, member number
I would like to be included in:
PgMP® PMP®
PMI Directories
PMI-ACPSM
PMI-PBA PMI-RMPSM
No
PMI communications (products, services, events)
PMI-SP®
Third Party Mailing Lists
First NameMiddle InitialLast Name
TitleEmail
Work PhoneCell Phone
All fees are listed in United States dollars
and must be paid in United States currency
Early
PMI Member Rate
Regular
PMI Member Rate
Non-Member
Rate
$665.00 (USD)
$1,325.00 (USD)
$1,985.00 (USD)
$2,645.00 (USD)
$725.00 (USD)
$1,445.00 (USD)
$2,155.00 (USD)
$2,845.00 (USD)
$855.00 (USD)
$1,545.00 (USD)
$2,275.00 (USD)
$2,955.00 (USD)
One Day Seminar
Two Day Seminar
Three Day Seminar
Four Day Seminar
Seminar Name:
Seminar Location:
Seminar Name:
Seminar Location:
Prefix
Mr.
Mrs.
Ms.
Dr. PMI Credentials
CAPM®
PMI Member
Yes, member number
I would like to be included in:
PgMP® PMP®
PMI Directories
PMI-ACPSM
PMI-PBA PMI-RMPSM
No
PMI communications (products, services, events)
PMI-SP®
Third Party Mailing Lists
First NameMiddle InitialLast Name
TitleEmail
Work PhoneCell Phone
All fees are listed in United States dollars
and must be paid in United States currency
One Day Seminar
Two Day Seminar
Three Day Seminar
Four Day Seminar
Early
PMI Member Rate
Regular
PMI Member Rate
Non-Member
Rate
$665.00 (USD)
$1,325.00 (USD)
$1,985.00 (USD)
$2,645.00 (USD)
$725.00 (USD)
$1,445.00 (USD)
$2,155.00 (USD)
$2,845.00 (USD)
$855.00 (USD)
$1,545.00 (USD)
$2,275.00 (USD)
$2,955.00 (USD)
Seminar Name:
Seminar Location:
Seminar Name:
Seminar Location:
Page 3 of 4
Group Registration Form
ATTENDEE INFORMATION & SEMINAR SELECTION
Please complete one section for each attendee. If you wish to select more than one seminar per attendee (for example (2) One Day
Seminars), write the quantity next to the rate and the name of both seminars and their location(s) where designated.
Prefix
Mr.
Mrs.
Ms.
Dr. PMI Credentials
CAPM®
PMI Member
Yes, member number
I would like to be included in:
PgMP® PMP®
PMI Directories
PMI-ACPSM
PMI-PBA PMI-RMPSM
No
PMI communications (products, services, events)
PMI-SP®
Third Party Mailing Lists
First NameMiddle InitialLast Name
TitleEmail
Work PhoneCell Phone
All fees are listed in United States dollars
and must be paid in United States currency
Early
PMI Member Rate
Regular
PMI Member Rate
Non-Member
Rate
$665.00 (USD)
$1,325.00 (USD)
$1,985.00 (USD)
$2,645.00 (USD)
$725.00 (USD)
$1,445.00 (USD)
$2,155.00 (USD)
$2,845.00 (USD)
$855.00 (USD)
$1,545.00 (USD)
$2,275.00 (USD)
$2,955.00 (USD)
One Day Seminar
Two Day Seminar
Three Day Seminar
Four Day Seminar
Seminar Name:
Seminar Location:
Seminar Name:
Seminar Location:
Prefix
Mr.
Mrs.
Ms.
Dr. PMI Credentials
CAPM®
PMI Member
Yes, member number
I would like to be included in:
PgMP® PMP®
PMI Directories
PMI-ACPSM
PMI-PBA PMI-RMPSM
No
PMI communications (products, services, events)
PMI-SP®
Third Party Mailing Lists
First NameMiddle InitialLast Name
TitleEmail
Work PhoneCell Phone
All fees are listed in United States dollars
and must be paid in United States currency
One Day Seminar
Two Day Seminar
Three Day Seminar
Four Day Seminar
Early
PMI Member Rate
Regular
PMI Member Rate
Non-Member
Rate
$665.00 (USD)
$1,325.00 (USD)
$1,985.00 (USD)
$2,645.00 (USD)
$725.00 (USD)
$1,445.00 (USD)
$2,155.00 (USD)
$2,845.00 (USD)
$855.00 (USD)
$1,545.00 (USD)
$2,275.00 (USD)
$2,955.00 (USD)
Seminar Name:
Seminar Location:
Seminar Name:
Seminar Location:
Page 4 of 4
Group Registration Form
PAYMENT INFORMATION
SeminarsWorld Cancellation/Substitution Policy
•
•
•
Full refunds, less $50.00 (US) processing fee per registrant, will be granted to cancellations received in writing
up to two weeks before the first day of the seminar.
Cancellations received less than two weeks before and
48 hours prior to the first day of the seminar are subject
to a $50.00 (US) service charge for each seminar day
cancelled, plus a $50.00 (US) processing fee. Refunds/
cancellations will not be given if cancellation is received
less than 48 hours prior to the first day of your registered
seminar. Refunds will not be granted for no-shows.
PLEASE NOTE: Credit card refunds may take 7-10 business days to reflect in your account.
If you register by invoice, you must pay all balances due
30 days prior to the first day of the seminar. If payment is
not received, your registration will be cancelled and your
seat in the seminar forfeited. After notification of cancellation, you may re-register by credit card only.
Seminar Changes: There will be a $50.00 (US) transfer fee
if seminar transfers are received up to two weeks prior
to your original registered seminar. After two weeks, a
$50.00 (US) transfer fee plus a $50.00 (US) per seminar
day fee will apply. No transfers will be accepted after the
first day of your original registered seminar.
If PMI cancels a seminar for any reason, they assume no responsibility for nonrefundable airline tickets or other travel costs.
PMI will make every effort to immediately notify registrants of
a cancellation. PMI reserves the right to cancel any seminar that
has insufficient enrollment.
CANADIAN TAX INFORMATION
In accordance with Canadian tax law, taxes are collected on
member dues and application fees relating to PMI and the following chapters: Canada’s Technology Triangle (CTT), Lakeshore,
Durham Highlands, New Brunswick, Levis, Manitoba, Montreal,
Northern Alberta, Nova Scotia, Ottawa Valley, Regina/S
Saskatchewan, Southern Alberta, South Western Ontario, and
Southern Ontario. The rate of tax charged varies depending on
the province address you use. Tax calculations by province are
15% for Nova Scotia, 13% for New Brunswick, Newfoundland/
Labrador and Ontario; 14% for Prince Edward Island; 14.975%
for Quebec; and 5% for all other provinces. If your employer is
paying for your membership and has been granted tax-exempt
status by the appropriate Canadian authorities, you will not be
able to submit your application on-line. You will need to mail or
fax your membership application along with a tax-exempt certification meeting the specifications of the Canadian government.
GST/HST registration: 897944807RT0001
QST registration: 1202723001TQ0001
CONFIRMATION will be e-mailed within seven to 10
business days of receipt.
Registration Inquiries?
Call 1-866-229-2386 (within the United States) or
+1-301-694-5243 (from all other locations) or
e-mail [email protected]
Please add up all attendee totals above for the TOTAL PAYMENT ENCLOSED section below.
If you have more than (4) attendees, you may print out additional pages. All pages need to be
included with registration and payment for processing.
TOTAL PAYMENT ENCLOSED $
Payments must be in the form of credit card, check or money order, paid in United States
dollars and drawn on a United States bank. Make checks/money orders payable to
"PMI SeminarsWorld." Please send registration and payment together. Registration forms
received without payment will not be processed.
PAYMENT TYPE
American Express
Discover
Check/Money Order
MasterCard
Visa Diners Club
Wire Payment
Card Number___________________________________________ Exp. Date ________/_______
Name on card:____________________________________________________________________
Signature:________________________________________________________________________
Wire Transfer Details:
Project Management Institute (PMI)
Wells Fargo Bank, N.A.
3515 West Chester Pike
Newtown Square, Pennsylvania 19073 USA
Account Number: 2000018429053
Routing Transit Number: 121000248
Swift Code: WFBIUS6S
* If submitting payment via wire transfer, funds must be received and verified by PMI no later than two weeks prior to
event start date. Registration is not confirmed/complete until attendee’s account shows a zero balance. Attendees will
not be permitted to attend the course until any outstanding balance is settled; please note a credit card is required to
complete payment onsite.
TO RETURN YOUR REGISTRATION AND PAYMENT MAIL TO (all pages):
Project Management Institute
P.O. Box 783301
Philadelphia, PA 19178-3301 USA
OR
FAX (all pages) to +1-301-694-5124 (For credit card payments only.)
NOTE: Confirmation from your fax machine does not mean that you are officially registered
for the event. Please wait until you receive an e-mail confirmation to make airline and hotel
reservations.