Workshop Registration Form

Systems Thinking 101: New Approaches to Organizational Challenges Waltham, MA November 4, 2002 Registration Form Print this form and FAX it to 1-781-894-7175 or MAIL it to Pegasus Communications, One Moody Street, Waltham, MA 02453-5339, Attn: Workshop Registration. To order by PHONE, call 1-781-398-9700.

Name (first, last)	__________________________________________________
First Name (for name tag)	__________________________________________________
Title/Position	__________________________________________________
Organization	__________________________________________________
Address	__________________________________________________
City	__________________________________________________
State or Province	_______________	Zip or Postal Code	_____________
Country	_______________
Phone	_______________	Fax	_____________
E-mail	_______________

Registration Fees
__Individuals			$450
__Each person in teams of four or more (total number ______)			$350
	Special Offer: Register by September 23rd and get a free one-year electronic subscription to The Systems Thinker®.
		Total enclosed	$_______

Method of Payment Payment must accompany registration form to enable processing. __Check Enclosed __Visa __MasterCard __American Express Card Number_________________________________ Exp. Date _____________ Signature____________________________________ Confirmations will be sent to you by e-mail. Please call 1-781-398-9700 if you have any questions. Cancellations and Substitutions All cancellations must be received in writing. Amount paid less a $50 processing fee will be refunded for cancellations postmarked or faxed by October 21, 2002. Cancellations after October 21 are not eligible for a refund, but a substitute may be sent—even at the last minute.