Mailing Address Black Career Women  P.O. Box 19332 Cincinnati, OH 45219-0332    Fax Number (513) 531 2166

BCW Mail or Fax Registration - Registration Closes Tuesday, Sept 12th noon est.
A Career Strategies Professional Development Seminar
You may register on-line with any credit card when online registration is available.

• Please print this registration page. Fill out all sections then mail or fax to BCW.
• American Express Card only accepted with Mail or Fax registrations
• Print this form to mail or fax to BCW

Registration Options:
(Please check one)
Standard Registration Rate of $150
Current BCW Member Only rate of $100
Late Registration Fee of $200 - After Friday, Sept. 8th

Seminar includes breakfast refreshments, lunch and registration materials.

Scholarship Request Area:

I am seeking a partial scholarship and a reduced registration
fee:
  
Please indicate why a discount is needed:

     
What amount are you able to pay? $_______
  
I can be available to assist with planning & implementation of seminar, in exchange for a reduced fee, at least 3-5 hours/3 days prior to seminar to assist with collating, registration or during/after seminar to help close out and tabulate seminar evaluations.
  
Deadline for Partial Scholarship requests - Friday, Sept. 8, 2006

BCW Seminar Materials Order Area:

Unable to attend. Please forward the Seminar Materials @ $60
Available after Sept. 15th.

Please forward electronically at below email address
email _________________________________

Please mail me a hard copy of materials at above address.

Please pay via BCW's online payment system (when available) to complete your on-line
registration.

If you prefer to mail in your payment, please do so no later than Sept. 1

Seminar Registration Form (Registration Closes Tuesday, Sept 12th noon est.)
Name:___________________________________________________________
Title:____________________________________________________________
Company or organization:___________________________________________
Mailing address: __________________________________________________
City, state, zip:____________________________________________________
Phone number: ___________________________________________________
Fax number: _____________________________________________________
E-mail: __________________________________________________________

Check number:____________________________________________________
Check amt.:______________________________________________________
To register, please enclose a check made payable to: Black Career Women, 
Mail to: Black Career Women Resources Center, Inc., P.O. Box 19332, Cincinnati, Ohio 45219.

Charge to (American Express Card):__________________________________
Card number: _____________________________________________________
Name as it appears on your card:______________________________________
Expiration date: ___________________________________________________
Signature: ________________________________________________________

(You may register on-line with any credit card when online registration available.) 

Mailing Address Black Career Women  P.O. Box 19332 Cincinnati, OH 45219-0332    Fax Number (513) 531 2166