Application Form

Name *
Organisation Position
Preferred mailing address: Organisation or Home please check one
Telephone *
Fax
E-Mail *
Please give details of academic qualifications
Previous cross-cultural training, coaching or courses
Please note that attendance is limited: We will inform you regarding acceptance to the course and will send you the registration/payment form. Fee information: Fees include course fees for CSUN credits (one per module), lunch, one group dinner per module and course materials, not accommodation. Participants can check hotels in Amsterdam: http://www.amsterdamhotels.demon.co.uk/locationlist.html , www.medialink.nl/amsterdam Very reasonable accommodation two doors down from venue: Hotel van Onna: Tel 31 20 6265801 The course Intercultural Communication is a 6-day course divided into 2 modules, which may be applied for separately. Please indicate whether you are applying for the whole course or for separate modules
2004	Corporate	Individual	Please fill in
Whole course: April 11 – 16, 2005	Euro 2250	Euro 1250
Module One: April 11 – 13	Euro 1350	Euro 750
Module Two: April 14 - 16	Euro 1350	Euro 750
Returned participants: 20 % discount

Course Administrator: Jorge Díaz, CIC Amsterdam, Marnixstraat 154-I, 1016 TE Amsterdam, The Netherlands Tel: 31 20 6242212, Fax: 31 20 6241513 jorgediaz@cic-amsterdam.com www.cic-amsterdam.com THANK YOU! * If you register by e-mail, please fax or post your credit card number rather than sending it through the Internet. *You can also download this Word document (application form.doc) to fill in.