2008 AKKA WKC Registration Form
| Convention Registration Form (Please Print) |
Name:
Title Last First MI
Spouse:
Children & Age:
Address:
City: State: Zip: Country: Cell#:
E-mail: Phone: Fax:
Registration Category (check all that apply) Check Donor Category benefits before entering the amounts
|Number of Attendees |Early Early Bird |Early Bird |Standard |Late |On site |Total |
| |Cut off Date |Cut off Date |Cut off Date |Cut off Date | | |
| | | | | | | |
| |Mar. 15, 2008 |May 4, 2008 |Aug 3, 2008 |Aug. 25, 2008 |Aug. 29-31, | |
| |(12 mid night, PST) |(12 mid night, PST) |(12 mid night,PST) |(12 mid night, |2008 | |
| | | | |PST) | | |
|( ) Adults (Per Person) |$175.00 |$200.00 |$225.00 |$245.00 |$275.00 | |
|( ) Children (7 – 18 Yrs)+ |$50.00 Discount off of Adult prices above | |
|( ) Continuing Medical ~ |$100.00 |$100.00 |$110.00 |$110.00 |$125.00 | |
|Education (8 Hrs.) | | | | | | |
|( ) Indian Registrants* |Flat Rate of $175.00 or Rs. 7,000.00 | |
|( ) Students on F1 Visa ^ |Flat Rate of $150.00 | |
|( ) Business Forum ~ |$100.00 |$100.00 |$100.00 |$100.00 |$100.00 | |
|Donors (Donations may be Tax deductible) |
|( ) Kannada Mitra |Complimentary registration for 2 |$600.00 | |
|( ) Kannada Datha |Complimentary registration for 4 |$1,100.00 | |
|( ) Kannada Kanda |Complimentary registration for 4 and Free Half page B/W ad in Souvenir |$1,500.00 | |
|( ) Kannada Rakshaka |Complimentary registration for 4; 1 Free Business Forum Ticket; Free Half Page B/W |$2,100.00 | |
| |advertisement in Souvenir | | |
|( ) Kannada Bandhu |Complimentary registration for 4; 1 Free Business Forum Ticket; Complimentary One room |$3,000.00 | |
| |for 3 nights; Free Full Page B/W advertisement in Souvenir | | |
|( ) Kannada Premi |Complimentary registration for 4; 2 Free Business Forum Tickets or 2 Free CME Tickets; |$5,000.00 | |
| |Complimentary One room for 3 nights; Free Full Page Color advertisement in Souvenir; | | |
| |Stage Recognition | | |
|( ) Kannada Kasturi |Complimentary registration for 4; 2 Free Business Forum Ticket; 2 Free CME Tickets; |$10,000.00 | |
| |Complimentary One Family Suite for 3 nights; Free Full Page Color advertisement in | | |
| |Souvenir; Limo transportation to and from airport; Stage Recognition | | |
|( ) AKKA Membership |Become AKKA Member now (see below for details) | | |
|Grand Total ($) | |
+ Age-appropriate baby sitting facility available for a standard fee. * Proof of current residency in India is required.
~ Convention Registration is a requirement. ^ Proof of F1 Visa number and Student ID number required.
|Registration for WKC-2008 includes – Food, Admission to Conference, & Souvenir. |
|Food Preference: Circle the Number: 1 2 3 4 5 Vegetarian ; 1 2 3 4 5 Non-Vegetarian |
| AKKA MEMBERSHIP DETAILS |
| |
|2 Yr Membership Family $50 Individual $25 |
|Life Membership Family $250 Individual $200 |
|Hotel Booking Information: Please make your own reservation |
|Crowne Plaza Chicago O’Hare |(limited # of Rooms held until August 14, 2008} |
|5440 N. River Road |$109+ Tax per room night |
|Rosemont, IL, 60018 |Group Code: AKA |
|Phone: 866-242-1055 |Website: |
|DoubleTree Hotel O’Hare Airport - Rosemont |(limited # of Rooms held until August 7, 2008} |
|5460 N. River Road |$109 + Tax per room night { SOLD OUT AT DISCOUNT PRICE } |
|Rosemont IL, 60018 | |
|Phone: 847-292-9100 |Group Code: AKK |
| |Website: |
|Other Benefits: Hospitality Committee Chair: |
|Ravi Harsoor: 630-229-5701, r.harsoor@ |
| |Payment Method |
|Registration Mailing address: |By Check: Payable to: “AKKA-WKC 2008 Conference” |
|AKKA WKC 2008 |By Credit Card: Card Type: (Visa (MC (Amex (Discover |
|319 N. Weber Rd. |Card Holder Name: ______________________________ |
|PMB #411 |Card Holder Address (If different): _____________________________ |
|Bolingbrook, IL 60490 |___________________________________________________________ |
|FAX Registration to: |Credit Card Number: ______________________________ |
|(267) 960-5427 |Exp Date: _____________ |
|Attn: AKKA WKC 2008 |Amount Authorized: $____________ |
| |Signature: _____________________________ |
|Web Registration: | |
|2008 |Date: _____________ |
|Contact Information: | |
|Mr. Narendra Lingegowda | |
|(847) 907-4647 | |
|wkc2008Register@ | |
|Cancellation Policy: |
|Registrations are Non Transferable |
|70% Refund if cancelled before June 30, 2008 |
|50% Refund if cancelled after June 30, 2008 – before July 31, 2008 |
|0 % Refund if cancelled after July 31, 2008 |
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Sight Seeing to Downtown Chicago is arranged for registrants at a nominal rate
Visit 2008/attractions.shtml for more details.
Preferred Airline: American Airlines: ( Code: wkc2008) Southwest Airlines: ( Code: * ) United Airlines: ( Code: * )
You can also get discount on British Airways from India, if the London – USA segment is on American Airlines.
Preferred Rental Car Agency: Avis ( Code: * ) Enterprise ( Code: * )
* will be provided later
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TAX ID: 59-3527607
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