MoC - Application Form

Microeconomics of Competitiveness - Application Form

Personal Information

*First Name:

*Last Name:

Nickname/Familiar name for Name Tag:

Title:

Gender:

*Date of Birth:

Citizenship:

*Home Address:

*Zip/Postal Code:

*Country

*Telephone Number (Home):

*Email Address

Organization Information

*Title/Position

Division

*Organization Name

Sponsoring Organization (Section not applicable for self sponsoring students)
Name of Organization
Name of Sponsoring Executive
Title/Position
Address:	P.O Box: Street: Town/City:
Zip/Postal Code:
Country
Telephone Number(Fixed):
Fax:
Email Address:
CANCELLATION POLICY Upon acceptance, payment in full is required immediately. Cancellations or deferrals must be submitted in writing up to 15 days prior to the start of the program to receive a full refund. Due to program demand and the volume of pre-program preparation, cancellations or deferrals received within 15 days prior to the start of the program are subject to a fee of one-third of the program fee; within five days are subject to two-thirds of the program fee. Cancellations or deferrals after the start of the program are subject to full payment.