Registration for 2011 Empowerment Institute

January 6–9, 2011 – Training at Delamater House, Rhinebeck, NY

(Training begins with dinner Thurs., Jan. 6th and ends at 6 pm before dinner
Sun., Jan. 9th)

January 10–June 7, 2011 – Return home to implement Empowerment Project.

June 8–12, 2011 – Training at Delamater House

(Training begins with dinner Wed., June 8th and ends at 6 pm before dinner
Sun., June 12th)

To register complete the form below.
Please provide all relevant information before submitting the form. Items marked with an asterisk * are required.

Registration Information

*Name:

Organization:

Title:

*Address:

*City:

*State: *Zip:

*Phone:

Fax:

*Email:

* required

I only eat vegetarian meals.

Select Your Track: *(required)

Track One

Track Two

Track Three

Track Four

Track Five

Track Six

Tuition:

Program tuition is $3,500 and includes program registration and materials for both trainings as well as support and coaching during the Empowerment Project.

Room and board at The Delamater Conference Center:
$1,710 for Single Room
$1,420 for Double Room
This includes lodging for seven nights (January and June sessions) as well as all meals during the two training sessions.

Checks and credit cards are accepted.

Cancellation Policy:

$2,000 of payment is non refundable. Refunds of the balance of your payment are made only in the case of a documented medical or health situation.

NOTE: A minimum of half payment for tuition and room and board is due upon registration. Full payment is due on or before December 1, 2010.

1. Tuition: *(required)

$3,500

2. Please indicate your room choice: *(required)

$1,710 (Single Room)

$1,420 (Double Room)

3. Add tuition plus room amounts and enter in appropriate box below:

I will make half payment of now.

I will make full payment of now.

Method of Payment:

Credit Card – (NOTE: Click this button to enter credit card info on our secure page, then you MUST return to this form and click on "Submit Registration" to complete your registration process.)

Check

I will pay by check payable to Empowerment Training Programs.
Register using this form and send check to:
Empowerment Training Programs
1649 Route 28A,
West Hurley, New York 12491

For questions and more information:
Empowerment Training Programs
1649 Route 28A,
West Hurley, New York 12491
845 331.1312
Fax: 845 331.3041