Foresight Perspectives Workshop Series
PRINT and fax or mail this form to:
Foresight Institute, Box 61058
Palo Alto CA 94306 USA
Tel: 650-917-1122 Fax: 650-917-1123
|If you are currently giving at the Friend level, use this form to register for one or more Perspectives workshops. Fill out only the Workshop Registration Section. If you are not yet giving at the Friend level, then fill out both the Senior Associate Sign-Up or Upgrade Section and the Workshop Registration Section. Then fill out the Payment Information and Contact Information sections.|
|___ Yes, I want to register for one or more Perspectives workshops. I am not yet a Senior Associate at the Friend level and am joining or upgrading at this time.||___ Yes, I want to register for one or more Perspectives workshops. I am already a Senior Associate at the Friend level.|
|Friend Sign-Up Section||Workshop Registration Section|
|My pledge is $5000 annually for five years. Includes engraved crystal "Friend of Foresight" award on ebonite base and the signed framed artwork. My first annual donation is:
___ New Senior Associate at the Friend level: $5000.
___ Upgrading from Associate: $4750.
___ Upgrading from Fellow: $4500.
___ Upgrading from Colleague: $4000.
This gift is an:
___ Individual contribution
___ Corporate contribution
___ A matching gift will be made by my company
My first annual donation is enclosed, payable to the Foresight Institute. Foresight is a nonprofit foundation; donations are tax-deductible in the U.S. to the full extent permitted by law. Donations can be made by check from a U.S. bank, postal money order, VISA, or Mastercard. Credit card donations may be sent by fax.
You will receive a receipt for your tax-deductible Senior Associate Friend donation.
|Sign me up for one or more Perspectives workshops. If I'm one of the first five to confirm, contact me for my thoughts on who to invite as resource people for the event. Sign me up for these sessions ($1500 donation per session):
Refunds of event fee only are available up to one month before event, minus $100 change fee. Substitutions may be made at any time. Foresight reserves the right to postpone workshops which have not met minimum participant requirements at least two weeks prior to event. If this occurs, event fees will be refunded 100%.
Registration cost can be paid by check from a U.S. bank, postal money order, VISA, or Mastercard. Credit card payments may be sent by fax.
Foresight Institute is a nonprofit 501c3 organization specializing in emerging technologies and their interaction with the law and public policy. Proceeds from the Perspectives series help fund Foresight's year round educational work as well as extensive public outreach via the web. Participants fees are tax-deductible in the U.S. as charitable donations as shown on your mailed receipt, or may be deductible in full as business expenses; consult your tax advisor.
|Payment Information||Contact Information|
|Total amount charged for Friend donation (if needed)
plus workshop registration: $____________
Name on credit card:_______________________________
VISA or Mastercard Number:________________________________
Exp. Date:_________ (Month/Year)
City, State: ___________________________________
Zip/Postal Code, Country: _________________________
Phone: __________________ Fax: __________________
Foresight materials on the Web
are ©1986-1999 Foresight Institute. All rights reserved.
Last updated 2July1999. The URL of this document is: http://www.foresight.org/SrAssoc/Perspectives/PerPrnReg.html