GIBV  2016 Annual Meeting Registration Form
 07/30/16 8:00 AM to 07/31/16 12:00 Noon at the Crowne Plaza Hotel, 320 Washington St, Newton, MA 02458
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First name *
Last name *
Phone Number (Area Code first) *
Use xxx-xxx-xxxx format. International applicants, please add country code + before phone number
Phone number above is Cell/Mobile [C] or Land line [L] *
Email Address *
Where possible, avoid giving your work email address
Street Address *
City *
State *
Zip Code/ Pin Code *
Country *
Emergency Contact information-1 *
Contact Name
Emergency Contact information-2 *
Contact phone number
Gender *
Age Group *
Middle Initial (Optional)
On an average, how much time could you devote for GIBV work per month? *
I will be *
(If flying, send itinerary to <info@gibv.org>, once you book the flight.)
I will arrive on *
I will depart on *
Transportation *
(If flying, send itinerary to <info@gibv.org>, once you book the flight.)
Only Vegetarian food will be served. Any Medical needs/condition that we should know about?
Will be kept confidential.
Registration Fee *
Registration fee of $125 includes all meals (two lunches, one dinner, two breakfasts, afternoon tea and snacks), and stay at the hotel on Friday and Saturday night (two persons sharing a double bed room.)  There is no discount for not staying at the hotel.
Required
Tel: 617-306-6609                                                                 Email: Kanchan.Banerjee@gibv.org                           Web site: www.gibv.org                                                                                                    Twitter:@Gibvikas Facebook: @Gibvikas
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