Retail Executive Leadership Program Registration Form

Retail Executive Leadership Program Registration Form
CONTACT INFORMATION
First Name
Last Name
Job Title
Company
Mailing Address
City
State/Province
Zip Code
Country
E-mail
Company Website
Phone
Fax
REGISTRATION INFORMATION
Early Bird Registration Fee Fees will increase after February 10th.	RELP, Both Programs (Non-IGA Member) - $3,200 RELP, Both Programs (IGA Member) - $2,900 Leadership Program Only (Non-IGA Member) - $2,400 Leadership Program Only (IGA Member) - $2,200 Family Business Program Only (Non-IGA Member) - $1,300 Family Business Program Only (IGA Member ) - $1,200
PAYMENT INFORMATION
Payment Type Your registration is not guaranteed until payment is received.	Credit Card: Contact us with your credit card information. Check: Make the check payable to the IGA Coca-Cola Institute and mail it to: 8745 W. Higgins Rd., Ste. 350, Chicago, IL 60631, USA
HOTEL Disney's Coronado Springs Resort 1000 West Buena Vista Drive, Lake Buena Vista, Florida, 32830 Room Rate (single/double): $149 USD per night plus tax (12.5%). This rate includes up to two adults (18 yrs and older) per room. Additional adults in the room pay $15 USD per person per night. Rates may change after February 10th. Room reservation deposit: each room reservation requires a deposit equal to cost of one night plus tax. This deposit is refundable if the reservation is cancelled at least five days before arrival. Contact us with your credit card information for the deposit.
Hotel Reservation	Please make a hotel reservation in my name. I do not need a hotel reservation.
Hotel Room	Single Double (2 Adults) Double (3 Adults) Double (4 Adults)
Name(s) of Additional Adult(s) in the Hotel Room
Arrival Date
Departure Date
OTHER INFORMATION
Language	English Spanish Portuguese
Class Program	Certificate - Classroom Only Diploma - Classroom and Online (No Additional Cost)
Do you have Vegetarian needs?	Yes No
TOURS Are you interested in attending the shopping (outlet mall) tour on the morning of Sunday, March 4th and/or attending the food retail tour on the afternoon of March 4th? Both tours are optional.	Shopping Tour Food Retail Tour Both Tours Neither Tour
Comments and/or Questions?