2009 ATHENA International Leadership
Summit Registration

* Name
* Address
* City
* State/Province
* Zip/Postal Code
* Country
* Phone
* Company Name
* Email
* Position (to appear on name badge)
*Check all that apply:
First time attendee
ATHENA Award Recipient
ATHENA PowerLink Affiliate
Past ATHENA Board Member
State/ Province Director

I am a member of the following partner organization:
WIPP
WLE
Other (write name in)


ATHENA AWARD RECIPIENTS (please complete)
Awarded by (city/state/ province)
Award Year

ATHENA POWERLINK AFFILIATES (please complete)
APL City
Year


COST
Registration fee includes: all conference and breakout sessions, Monday and Tuesday breakfast and lunch and Sunday Night Welcome Reception. The Monday night Odyssey Dinner Cruise is an additional cost and is optional. To purchase additional tickets for guests to receptions or keynote luncheons ($95), please contact ATHENA International.
Early Bird Conference Registration (prior to February 15) $350
Conference Registration (after February 15) $400
Group rate for 20 or more (must be submitted together) $350
Odyssey Celebration Dinner Cruise (optional) Mon, March 16, 6-10 p.m. $110 each
Individual Ticket for Monday or Tuesday Luncheon $95 each
Table Sponsorship for Monday or Tuesday Luncheon $1000
I AM REDEEMING A CONFERENCE CERTIFICATE (CERTIFICATE NUMBER REQUIRED)
TOTAL AMOUNT DUE
Please enter total amount to proceed to PayPal after submitting the form


PLEASE HELP US PLAN BY INDICATING IF YOU WILL ATTEND THE FOLLOWING EVENTS (INCLUDED IN YOUR CONFERENCE REGISTRATION):
Sunday Evening Welcome Reception Yes No


Monday Breakout Session: ATHENA Programs: Overview & Best Practices Yes No
(if yes, choose one session) ATHENA AWARD PROGRAM
ATHENA POWERLINK


Tuesday ATHENA Recipient/APL Affiliate Breakfast & Photo Shoot (for ATHENA Recipients/ APL Affiliates only) Yes No

OPTIONAL EVENT (Comes at an additional cost)
Monday Evening Odyssey Network Dinner Cruise ($110 per person) Yes No


INDIVIDUAL TICKETS AND TABLE SPONSORSHIP (for those not attending entire ATHENA Leadership Summit)

Individual Ticket for Monday for Luncheon $95 each  
Individual Ticket for Tuesday's Luncheon $95 each  
Table Sponsorship for Monday or Tuesday Luncheon
(includes table of 10 and recognition in program materials)		 $1000 per table  
Name of Sponsor Organization
   
Your Name
Your Company
Your Email Address
Your Phone Number
 
Monday, 3/16/09  
Keynote Luncheon: Dr. Gail Evans, Author & CNN News Executive: Creating Your Own Rules & Playing By Them
Number of Tickets
Number of Tables
   
Guest 1 Name
Guest 1 Company
Guest 1 Email
Add Another Guest (Max of 9 Guests)  

Tuesday, 3/17/09  
2009 International ATHENA Awards Celebration Luncheon
Number of Tickets
Number of Tables
   
Guest 1 Name
Guest 1 Company
Guest 1 Email
Add Another Guest (Max of 9 Guests)  
   



Dietary Restrictions
Accessibility Needs



 
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