Leadership Workshop Application

Practicing Leadership in a Political Environment

9:00 am - 4:00 pm Saturday, January 23, 2010
Hilton University of Florida Conference Center
Gainesville, Florida 32607

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

Title*
Family/surname/last name*
Given/first name*
Working title*
Organization/Dept.*
Email*
Website
Phone* include city, country, or area code(s)
Fax include city, country, or area code(s)
Mailing address*
City*
State
Zip/postal code*
Country*
Years of Professional Experience in Regulatory Issues*
Years of Professional Experience in Management*
In case of emergency, contact* name, phone, fax
Dietary restrictions/Food Allergies:*

Payment of Workshop Fee

The registration fee for the PURC Leadership Workshop is US $550 for 27th PURC/WB International Training Program participants.

For all others, the registration fee for the workshop is US $650.

The registration fee includes tuition, workshop material in English, reading material, lunch, and morning and afternoon snacks. You will be informed on the status of your application upon receipt within six business days. Accepted workshop applicants will receive further information regarding the payment of course fees, hotel accommodation, other logistical arrangements, etc.

Please remember that seating is limited and that proof of payment is due on or before Friday, November 20, 2009.

If you wish to register after November 20, 2009, please contact Jeri Shell or Melissa Stevens at PURC via e-mail at or via phone at (+1) 352-392-3655 or (+1) 352-392-6148.

I have read and do understand that, if I am accepted to participate at this course, my proof of payment will be due on or before November 20, 2009.

Cancellation Policy

Cancellation requests must be made in writing via e-mail at or via fax at (+1) 352-392-7796. A 20% cancellation fee will apply to all requests for refunds received on or before Friday, December 11, 2009. After December 11, 2009, no refunds will be granted.

I have read and do understand the cancellation policy.

Hotel Accommodation

Accepted applicants will be responsible for reserving their own accommodations by contacting the Hilton University of Florida Conference Center Gainesville directly. A block of guest rooms is being held under the name Leadership Workshop at the Hilton University of Florida Conference Center Gainesville in Gainesville, Florida, USA, checking in Friday, January 22, 2010, and checking out Sunday, January 24, 2010. The special conference rate(s) are quoted per person, per night at a rate of US $94 plus tax. Please note that the Hilton University of Florida Conference Center Gainesville will assess a one night penalty for any cancellations not received within 24 hours of your stay.

Hilton University of Florida Hotel and Conference Center
1714 SW 34th St
Gainesville, FL 32607
(352) 371-3600

Services for Persons with Disabilities

Please contact us at or phone us at (+1) 352-392-3655 or (+1) 352-392-6148 at least 72 hours prior to the beginning of the event.