2016 QIIC Registration

 

 

Please complete the registration form, then complete the payment information at the bottom of the page.

 

Fields with marked with an *asterisk are required 

Submit

Thank You!

The form has been successfully sent.

Credit card payments can be made below after submitting this registration form, or by contacting ICI directly by phone or fax.  

Checks can be made out to Intercultural Communication Institute and mailed to:

 

Intercultural Communication Institute

8835 SW Canyon Lane Suite 238

Portland, OR 97225

Phone: 503-297-4622

Fax: 503-297-4695

*Choose your 2-Day workshop:

*Choose your 1-Day workshop:

*Name:

This field is required.

Nickname (For Nametag):

*Email Address:

This field is required.

Title:

Organization:

How many years have you attended QIIC?

*Address is:

Home
Work
Both

*Mailing Address:

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*City:

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State:

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Zip or Postal Code:

*Country:

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Phone #1:

Phone #1 Type

Home
Work
Cell

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Phone #2:

Phone #2 Type

Home
Work
Cell

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*Method of Payment:

U.S. Bank Check / Money Order
Purchase Order
Credit Card

If paying by purchase order, please enter the number:

If paying by Paypal, please enter the name on the account:

Notes:

This field is required.

Please complete the registration form, then complete the payment information below.

2016 QIIC Registration

 

 

Please complete the registration form, then complete the payment information at the bottom of the page.

 

Fields with marked with an *asterisk are required 

Please complete the registration form above, then complete the payment information below.

Submit

Thank You!

The form has been successfully sent.

Credit card payments can be made below after submitting this registration form, or by contacting ICI directly by phone or fax.  

Checks can be made out to Intercultural Communication Institute and mailed to:

 

Intercultural Communication Institute

8835 SW Canyon Lane Suite 238

Portland, OR 97225

Phone: 503-297-4622

Fax: 503-297-4695

*Choose your 2-Day workshop:

*Choose your 1-Day workshop:

*Name:

This field is required.

Nickname (For Nametag):

*Email Address:

This field is required.

Title:

Organization:

How many years have you attended QIIC?

*Address is:

Home
Work
Both

*Mailing Address:

This field is required.

*City:

This field is required.

State:

This field is required.

Zip or Postal Code:

*Country:

This field is required.

Phone:

Phone Type

Home
Work
Cell

This field is required.

*Method of Payment:

U.S. Bank Check / Money Order
Purchase Order
Credit Card

If paying by purchase order, please

enter the number:

If paying by Paypal, please enter

the name on the account:

Notes:

This field is required.

 

The Intercultural Communication Institute 

Intercultural Communication Institute

 8835 SW Canyon Lane, Suite 238 

Portland, OR 97225 

Phone: 503-297-4622

ici@intercultural.org

TEACH WISELY - TRAIN EFFECTIVELY - MANAGE THOUGHTFULLY