Application for Admission

27th International Training Program on Utility Regulation & Strategy

January 11-22, 2010 - Gainesville, Florida

Dear applicant: This application form has been designed to obtain all the information we may need from you during the application/registration process to attend our program. We ask that you please submit clear and accurate information to avoid any delays. Our Admissions Committee will review your application as soon as possible. Accepted applicants will be informed via e-mail immediately after a decision on their application is reached.

Qualified applications received after October 16, 2009 will be accepted based on availability. We encourage all applicants to submit their applications as early as possible so that they have enough time to obtain an entry visa to the USA if needed, etc.

Please note: The sessions will be conducted in English, so participants must have a good command of this language.

Please fill out all fields on the form below. *Required fields.

Personal Information

Title*
Family/surname/last name*
Given/first name*
Middle name
Name for badge*
Telephone* include city and country code
Fax include city and country code
Email address*
Website
In case of emergency, contact* name, phone, fax

Job Details

Title of present position*

Institution/company*

Work street address*

Work city*

Work state

Work zip/postal code*

Work country*

Which infrastructure sector(s) are you personally involved in regulating or operating?*

Electricity	Gas
Telecom	Water
Other:

Number of staff dedicated to regulatory tasks
for regulators only

Number of individuals employed by your company
for infrastructure companies only

Number of employees in activity you manage
for company employees only

Describe your current duties*

Please check whether you are personally involved in the following types of issues:*

	Determination of market structure issues
	Design and administration of infrastructure arrangements with private sector providers (e.g., divestiture, concession, license, lease)
	Determination of regulated prices
	Determination of quality/performance standards
	Administration of competition rules in regulated sectors
	Administration of subsidies and transfers to low-income groups

Previous Positions

Position #1*
Company/Institution*
Dates*
Duties*
Position #2*
Company/Institution*
Dates*
Duties*

Training Program

Please describe your reasons for wishing to participate in the training program, and your expectations of it:*
Dietary Preferences/Food Allergies:*

Hotel Room

Bed preferences*	One king-sized bed Two double beds
Smoking preferences*	Non-smoking Smoking
Will you be accompanied by a non-participant(s)?*	Yes . How many? No
I plan to attend the Basic Economic Training Session, Sunday, January 10, 2010, 2-4:30pm.*	Yes No
I would also like to attend the PURC leadership workshop, Practicing Leadership in a Political Environment, on Saturday, January 23, for only US $550. More Information.	Yes No

This constitutes my completed application. I realize that applicants will be selected according to their current position and relevant professional expertise and to maintain cross-sectoral, cross-regional, and national balance.

I understand that if I am accepted to participate in the program, proof of payment for my attendance will be due Friday, November 20, 2009 (US$5,900 for regulators or US$6,900 for staff from private or public infrastructure companies). I will submit proof of payment via fax to (+1) 352-392-7796 or via e-mail to by November 20, 2009.

Full payment must be received by the payment deadline, Friday, November 20, 2009, in order to guarantee your seat at the program. If full payment is received after the payment deadline and should there be seats available, this may result in alternate hotel accommodations arranged at the discretion of the PURC Program Committee.

I understand that cancellation(s) must be sent to PURC in writing on or before Friday, December 11, 2009 for a refund, minus a US$600.00 cancellation fee. After December 11, 2009, only 70% of the fee will be refundable (with additional charges for no-shows).