USVI Public Records

Document text

University of the Virgin Islands Global Institute for Leadership and Management Development (UVI – GILMD) Registration Payment Form for International Conference on Management, Leadership and Strategic Development, St. Thomas, USVI – May 23-25, 2017 INSTRUCTIONS: Complete this Registration Payment Form and email or post it to: Dr Gabriel Ogunmokun, Director – Global Institute for Leadership and Management Development, University of the Virgin Islands, RR1 Box 10000, Kingshill, St. Croix, US Virgin Islands 00850-9781 Email: ogunmokun@academyofworldbusiness.com; gogunmo@uvi.edu Title:  Prof  Dr  Mr  Mrs  Ms  Other: _______ Full Name: University/Organization Name and Address: Email address: Mobile Phone Number: Presenter or Non-Presenter: CONFERENCE REGISTRATION FEE Conference Registration Fee covers the Welcome Reception, all Conference Sessions, morning and afternoon coffee/tea breaks, two Working Lunches, Conference Dinner and the Conference Proceedings. (Late registration will incur 5% additional charge) COST AMOUNT TO BE PAID Full Registration (on or before May 9, 2017) USD 575.00 USD Early Registration (on or before April 18, 2017) USD 500.00 USD Full Student Registration (on or before May 9, 2017) USD 475.00 USD Early Student Registration (on or before April 18, 2017) USD 400.00 USD Extra Ticket for the Welcome Reception (if bringing a guest) USD 25.00 USD Extra Guest Ticket for Conference Dinner (if bringing a guest) USD 35.00 USD TOTAL USD PAYMENT METHODS AND INSTRUCTIONS (Cash is not accepted) Check Box Payment by Money Order or Bank Check (Not Personal Check): Make payable to “GILMD – University of the Virgin Islands.” Mail to the above address, together with this Registration Payment Form. Note: Please email a scanned copy of the check to the Director before mailing the original. You will be emailed a receipt. Payment by Credit Card by Email: Complete the information required below and email this Registration Payment Form to the Director to forward to the UVI Cashier for processing. You will be emailed a receipt. Payment by Credit Card by Phone: Call the UVI Cashier’s office directly for them to take the credit card details over the phone on (340) 693-1437 or Mr Robert Chen on (340) 693-1143. State it is for Conference Fees for the Global Institute Account No. 259870 – 55220 and provide your name, email address and university. You will be emailed a receipt. Note: You still need to complete and email this Registration Payment Form to the Director (but only put the last four digits of the credit card number) UVI Faculty/Staff Members: Name of the School/College paying your Registration Fees: _____________________________________________________________________ Dean’s Signature: Date: Please charge my: MASTERCARD VISA CARD AMEX NAME ON CARD: CARD NUMBER: EXPIRY DATE: 3-digit security number on the back of card: