Online Registration

Title (Dr/Mr/Ms/other):

Your name:                  (Required)
Your email address:       (Required)
Telephone number:          (Required)
Your fax number:

Position:

Employer:

Address:

City, State: Postal code:

Country:

Fulbright Country & Year:

Discipline/Field:

Name of spouse/partner:

(Additional fee for a spouse/partner is $200)

PARTICIPATION:

Sunday Seminars:

My preference for the Sunday Seminar is below (space is limited to 40 per seminar):

Options: (a) Entrepreneurism, (b) Global Health, (c) Sustainable Agriculture, (d) FAST Futures, (e) Not Participating on Sunday. (For a brief description, see bottom of this page.)

I/we sould like to be an Exhibitor/Sponsor: (yes/maybe/no)

I heard about the conference from:

(internet, alumni group, mailing, colleague, etc.)

Comments/special needs:

PAYMENT OPTIONS:
(a) Mail check, (b) fax credit card, or (c) click on Google Checkout button at the TOP of this form after you have submitted your registration data, and you can use your credit card to pay on-line If Google Checkout is not available in your country, please fax your credit card information to +1-815-846-1756.

Amount to be paid? (see table below for registration fees)

Payment date & method

(Date of payment, followed by "mailed check", "faxed credit card information" or "submitted payment via internet")

YOU ARE ALMOST DONE ...

Please click on the "SUBMIT" button to submit the above information.

If you did not use our secure internet-pay option to pay for your registration, please print this page and fax your credit card information to +1-815-846-17856 or mail a check (payable to a US bank).

REGISTRATION RATE INFORMATION:
The deadline for advance registrations is February 10, 2010. Rates will increase by up to $35 after that date.

Regular rate ($450): This rate is for "professionals" - people who work for the government, institutions of higher education, corporations, and foundations in high income countries. Individuals from low- and middle-income countries who work for entities that pay international wages should also pay this rate.
Reduced rate ($300): This rate is for staff at non-profit organizations, current senior Fulbright scholars and teachers. Please indicate your institution's name on the registration form. People with emeritus status should include their birth year/retirement year.
Extra Reduced Rate ($175): This rate is for current student grantees and individuals from low- and middle-income countries (if they work for a local entity that does not pay on an international wage scale). This rate is also for representatives of national Fulbright alumni associations.
Spouse/family rate ($200): If you are accompanied by a family member, he/she can participate in the programs and attend the meals and tours for a reduced fee.
Opening Night Gala ($75): The Opening Night is included with the regular registration. A small number of tickets are available for Bay area alumni and friends who wish to attend.
Just the Sunday Seminar ($100): A small number of places in the Sunday Seminars are available to those who can only participate on Sunday.
Member Discount: The fifty dollar ($50) discount is available to employees of institutional members. Existing individual members should register at the normal rate, and they will receive a one-year extension on their membership.
Registration waivers: Because of our policy on "Equality of Membership" we do not offer complimentary registrations. All participants are expected to contribute financially.
Sponsored registrations / Special cases: A small number of sponsored registrations will be available. If the regular registration rates are above your ability to pay, you may petition FAST for a discount. FAST is also willing to assist you on funding requests to employers or other entities.
Cancellations: Those who cancel their conference registration on or before January 15 will be eligible for a full refund. Those who cancel on or before February 15 will be eligible for a refund minus a US$75 administrative fee. No refunds will be issued for cancellations received after that date. Cancellation requests must be submitted to FAST in writing. If the conference must be postponed or moved by FAST due to natural disaster or a terrorist or related incident, partial refunds may be issued. Hotels will have their own cancellation policy for your accommodations - contact your hotel for details.
Accidents/Injury: Your participation in the FAST Conference may involve travel to off-site locations, and you may be exposed to a variety of hazards and risks, foreseen and unforeseen. By registering for the conference, you agree to waive, discharge claims and release from liability the Fulbright Academy, Inc., its officers, directors, employees, agents and leaders from any and all liability on account of, or in any way resulting from, injuries or damages. In registering for the conference, you understand and intend that this assumption of risk and release is binding upon your heirs, executors, administrators and assigns, and includes any minors accompanying you.

SUNDAY SEMINARS: (there is a box above for recording your preference)

Entrepreneurism - day-long program with Fulbright entrepreneurs, investors, inventors, and business school leaders.
Global Health - day-long program with Fulbright leaders in medicine, nursing, public health, pharmacy and other health-related professions.
Sustainable Agriculture - day-long trip to Davis, CA, with visits at Campbell Soup's vegetable research center and UC Davis.
FAST Futures - day-long program for Fulbrighters in sectors not represented in the other three seminars to explore opportunities for international collaboration among grantees and alumni.
Not participating - some participants must leave on Sunday in order to be at work on Monday morning.

Our Mailing Address

FAST --- PO Box 284 --- Cape Elizabeth, ME 04107-0284 --- United States

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