First Name

Last Name

Professional Title/ Institutional Affiliation

Organization

Address

State/Province

City

Zip/Postal Code

Country

Office Phone

Home Phone

Fax

e-mail

I WILL PARTICIPATE AS:
PAPER PRESENTER

YES
NO

(give a title of your presentation):

DISCUSSANT

YES
NO

(give a topic of your interest):

I AGREE TO CHAIR A SESSION
(if necessary)

YES
NO

 

MEMBERSHIP FEES (in USD)

All participants must join or be members of COPE, INTL
Choose membership category:
I am already a life member of COPE



Life membership ($500USD)

$

Annual membership ($75USD)

$

 

REGISTRATION FEES (in USD)

CONFERENCE REGISTRATION $300USD (required of all participants, including: coffee breaks, refreshment breaks, banquet, conference rooms with equipment)

$

PUBLICATION FEE
(optional, for publication of paper in conference book)
$125USD - per paper

$

BANQUET TICKETS FOR PARTICIPANT'S FAMILY MEMBERS OR GUESTS $50USD

$

EDUCATIONAL TOUR
 

In case of cancellation before June 1, 2017 50 % of Registration Fee will be refunded.
In case of cancellation after June 1, 2017 Registration Fee will not be refundable!


Total Charges:


$

 

PAYMENT INFORMATION

 

Payment information should be completed in order for registration to be processed.
Payments can be made by Visa, Master Card, Wire Transfer or by Cheque

VISA
MASTERCARD
Cheque (payable to COPE)
Wire Transfer




CARD NUMBER

SECURITY CODE (3-4) DIGIT (See Back of Your Card)

EXPIRATION DATE

 mm/yr

 


Payments must be completed by May 1, 2017

Additional Information

 

PLEASE NOTE: THIS IS NOT SECURE SITE.

Wire Transfer - Email
        Email congofpoli@gmail.com
Swift Number  Bank Routing Number: Email
Account Number: Email congofpoli@gmail.com
 (Be sure that All Names of Participants and Institutional Affiliation
appears on transfer document) 
 Immediately after sending wire with payment Email at congofpoli@gmail.com at telling her about the transfer. Please list the amount paid for each participant and
what it is being paid.

Please mail cheques to: Wilkes University
c/o COPE
Congress of Political Economists

84 w.South street
Wilkes-Barre, PA 18766 USA

You can also copy the Registration form and fax or mail it

.. ..



© 2017 Congress of Political Economists

COPE Registration Form

(Please print all information)