Conference Form

Work Life Balance Event

February 2, 2006

"Leading Your Strategic Work Life Portfolio"

Host: KPMG, 1601 Market Street, 36th Floor, Philadelphia

8:30 a.m. -12:00 pm.

Register by website, phone, fax or email

The Conference is designed for: -Work/Life Professionals -Government Affairs Representatives -Human Resource Professionals--Work/Life Academics, Diversity and Leadership Professionals

It’s a great opportunity to feature your Work/Life products and services. Contact us at wlb@worklifebalance.org.

Please Fill in the Information Below a
Contact Person
Title
Organization
Address
City
State
Zip
Phone
Fax
E-Mail
Web Site


Work/Life Balance Conference Fees a
(If you are not a WLB member, you can save money by signing up for an WLB membership when you register.

Registration Fees
Non-Member $85
Individual WLB Member $65
Special Member Organization Rate $65
Corporate or Level II Member ($65)
Sponsoring WLB Member (up to 2 representatives free)
Exhibitor (contact WLB for rate Information)

WLB Membership Fees a
Individual Member Fee $150
Non-Corporate $350
Corporate $500
Supporting $1500
Sponsoring $5000
Level I Associate $150
Level II Associate $500

Please fill in all that apply: Registration Rate Membership Fee
a
Payment Amount:

Check Enclosed a
If you pay by check, please make payable to WLB (Tax I.D. # 31-1514295) Mail to: Work/Life Balance, P.O. Box 236, Newtown, PA 18940.

Important Note: Please print form and fax creditcard information in order for security. 215-757-4007 FAX. Thank you. a
VISA Master Card American Express Name on Card: Card No: Exp. Date:

Fee & Payment Information: Payment is due prior to the conference and can be made by check. Please make payable to Work/Life Balance and write the name of the attendee(s) on the face of the check. Payment must be made one week prior to event.

Cancellation Policy: Should you be unable to attend, a refund will be given up to 7 days before the event with written cancellation. Registered attendees who do not attend or who cancel less than one week before the conference are responsible for the entire fee.


Special Needs/Dietary Requirement: If you have special requirements for your attendance, please fill out and return this form to WLB, along with registration and payment. Special Need:

The Conference is designed for: -Work/Life Managers -Government Affairs Representatives -Human Resource Directors -Work/Life Providers -Work/Life Academics, Consultants and Vendors

Please contact us if you have questions or need more information

P.O. Box 236
Newtown, PA 18940
Phone/Fax: 215-757-4007
wlb@worklifebalance.org