Foresight Perspectives Workshop Series
Workshop Registration Form

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):

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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)

Signature ________________________________
    Name: ___________________________________

Address: ___________________________________

Address: ___________________________________

City, State: ___________________________________

Zip/Postal Code, Country: _________________________

Phone: __________________ Fax: __________________

Email: ___________________________________

Perspectives Series

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