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2019 IPO Innovation Dialogue Trip to Asia Registration Form

/2019 IPO Innovation Dialogue Trip to Asia Registration Form
2019 IPO Innovation Dialogue Trip to Asia Registration Form 2019-08-21T10:22:39-04:00

    Name: (required)

    Organization:

    Title in your Organization:

    Address:

    City:

    State:

    Zip:

    Country:

    Cell Phone (in case of emergency during the trip):

    Email: (Required)

    Will you attend the Welcome Dinner in Beijing on Sunday, Nov. 3? (yes or no)

    This dinner is highly recommended for attendees to discuss the topics during the trip.

    Do you require a VISA invitation letter? (yes or no)

    If yes, please provide the following information by Sept. 6: 1) Name as it appears in your passport 2) Official title in your organization if different than above. 3) A clear copy of your photo and information page in your passport e-mailed to Clara Stanfield (cstanfield@ipo.org)

    Please check so we may stay in contact with you.

    I consent for IPO to contact me about IPO & IPO Education Foundation news and events. Yes, I consent to contact me.
    I consent for IPO to list my name, organization, and location on attendee lists (printed and electronic) for IPO & IPO Education Foundation events that I am registered for. Yes, to list my name.

    Registration Fee: $2,250 (Credit card or invoice)

    Credit CardPlease send me an invoice
    Registration is not complete until payment is received.

    Credit Card Information (if applicable)

    Card Number:

    Exp. Date:

    Please answer this security question:
    Confirmation will be sent within two business day.