November 14–16, 2005
San Francisco, CA

Decisions made within six weeks of receipt

DIRECTIONS: Following the numbering and format as shown below, please submit in typewritten form by mail or fax (781-894-7175), or by email (as a Word document) to stascholarships@pegasuscom.com. Please respond to each item or question.

No full scholarships are available (if you are interested in working at the conference in exchange for a registration, see the session assistant application).

If you, or your organization, need financial assistance in order to register for the conference, please provide the following:

1. Personal Information
Name (Mr/Ms)
Title/Position
Organization/Affiliation
Street Address
City, State, Zip/Postal Code, Country
Phone(s)
Fax, E-mail (If you don't have your own fax or e-mail, please list the e-mail or fax of a friend, colleague, or fax service.)

2. Need for Financial Assistance
Scholarship awards are based on need. Please describe your need for financial assistance.

Please indicate how much you are able to pay towards the conference registration fee: $ ______.
(Minimum is $595). Full scholarships are not available. Please keep in mind that the regular conference registration fee ranges from $950–$1595 depending on when you register.

3. Involvement in Systems Thinking and Organizational Learning
Please provide a brief description of your involvement in the field of systems thinking and organizational learning (one paragraph maximum).

4. Benefit to Yourself and Others
Please tell us how you would use your attendance at the conference to benefit yourself and others (one paragraph maximum).

5. If You Have Attended Before—
Name of colleague you are submitting your application with:__________________________

6. Application Choices
___ I am applying only for a scholarship, OR
___ I am submitting applications for a scholarship and a session assistantship (knowing I may only accept one or the other).
If you are submitting two applications, also choose one of the following:
My preference is for a scholarship ____ or a session assistantship ____.

If you have any questions please contact the Conference department (781-398-9700 or conference@pegasuscom.com).

Pegasus Communications, Inc.
One Moody Street
Waltham, MA 02453-5339
Phone: 781-398-9700 • Fax: 781-894-7175

E-mail applications to stascholarships@pegasuscom.com