Paris 2013 Registration        
                          

 

 


Primary Traveler Additional Traveler Submit Confirmation

 

!!!PROGRAM OPEN FOR WAITLIST REGISTRATION ONLY!!!

We hope you can join the AYA and fellow Yale Alumni in this extraordinary opportunity - an opportunity to be an ambassador for Yale and the U.S. and to help develop alumni leadership at world leading universities in Paris from February 12 - 17, 2013 (note that means leaving the U.S. on February 11). Please complete your application as early as possible - applications are being considered based on your volunteer leadership at Yale. We are offering the Yale Global Alumni Leadership Exchange with universities and the parallel Global Higher Education Summit. You will be asked to indicate your preference in the registration form. If you are not selected for the program you choose, your full deposit will be returned. The deadline for applications to the program is December 1, 2012 (on-line submittal of information and credit card payment or receipt of a check at AYA of the deposit of $1,000 per person towards the $3,000 total cost of the program per person).

If you have any questions, please contact the AYA (either (i) Kathy Edersheim: (203) 432-1938, or kathy.edersheim@yale.edu; or (ii) Marv Berenblum at mberenblum@nesc.org.) For information about YaleGALE, visit our website at www.yalegale.org.

Please read the Terms and Conditions before completing the registration.

Required fields are marked with an "*"

PRIMARY TRAVELER - STEP 1

 

 
YaleGALE Paris Deposit $1,000.00 # of People
______________________________________________________________________________________ 

Primary Traveler Contact Information 

First Name: * 
Last Name: * 
Informal First Name (for name badge): 
Address: * 
Address 2: 
City: * 
State/Province: * 
Postal Code: * 
Preferred Phone: * 
Alternate Phone: 
E-mail: * 
Date of Birth: (DD/MM/YYYY) * 
Yale Affiliation, if any: 
Yale Degree(s), if any: 
Degree #1 Type a school name: 
Degree #1: 
Degree #1 year: 
______________________________________________________________________________________ 

Business Information 

Occupation (If retired, from what position & company?): 
Title: 
Company Name: 
Business Address: 
Business Address 2: 
Business City: 
Business State/Province: 
Business Postal Code: 
Business Phone: 
Business Fax: 
Business E-mail: 
______________________________________________________________________________________ 
Extension Final Payment $800.00