2018 Annual Meeting & Conference Registration Saturday, 06/09/18 8:00 AM to Sunday, 06/10/18 9:00 PM at Americas Best Value Inn, 485 S. Main St., Milpitas, CA 95035 1-855-873-6558 Your contribution to GIBV is tax deductible. If you plan to send a check for registration or pay at the meeting, please register yourself by downloading this form and sending it to Ms. Somanjana Chatterjee, GIBV, 1532 Marlene Court, San Jose, CA 95118 *First Name *Last Name *Phone number (Area code first) Use xxx-xxx-xxxx format. International applicants, please add country code + before phone number *Is this cell (mobile) or land line number? Cell/Mobile Land line *Email address Where possible, avoid giving your work email address *Street Address *City *State *Zip code/ Pin code *Country USA Other - - - Select - - - Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua Argentina Argentina western prov Armenia Aruba Ascension Australia Western Australia South Australia Northern Territory Australia New South Wales Australia Queensland Australia Victoria Australian Capital Territory Australia Tasmania Australia Lord Howe Island Austria Azerbaijan Azores Bahamas Bahrain Balearic Islands Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia Hercegovina Botswana Brazil West Brazil Acre Brazil East Brazil Atlantic Islands British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Yukon & Pacific Canada Mountain Canada Central Canada Eastern Canada Atlantic Canada Newfoundland Canary Islands Canton Enderbury Islands Cape Verde Caroline Island Cayman Islands Central African Rep Chad Channel Islands Chile China Christmas Islands Colombia Congo Cook Islands Costa Rica Cote dIvoire Croatia Cuba Curacao Cyprus Czech Republic Dahomey Denmark Djibouti Dominica Dominican Republic Easter Island Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Island Fiji Finland France French Guiana French Polynesia Gabon Galapagos Islands Gambia Gambier Island Georgia Germany Ghana Gibraltar Greece Greenland Greenland Thule Greenland Scoresbysun Grenada Grenadines Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia West Indonesia Central Indonesia East Iran Iraq Ireland Republic of Israel Italy Jamaica Japan Johnston Island Jordan Kazakhstan Kenya Kiribati Korea Dem Republic of Korea Republic of Kusaie Kuwait Kwajalein Kyrgyzstan Laos Latvia Lebanon Leeward Islands Lesotho Liberia Libya Lithuania Luxembourg Macedonia Madagascar Madeira Malawi Malaysia Maldives Mali Mallorca Islands Malta Mariana Island Marquesas Islands Marshall Islands Martinique Mauritania Mauritius Mayotte Melilla Mexico Mexico Baja Calif Norte Mexico Nayarit Mexico Sinaloa Mexico Sonora Midway Island Moldova Moldovian Rep Pridnestrovye Monaco Mongolia Morocco Mozambique Myanmar Namibia Nauru Republic of Nepal Netherlands Netherlands Antilles Nevis Montserrat New Caledonia New Hebrides New Zealand Nicaragua Niger Nigeria Niue Island Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pingelap Poland Ponape Island Portugal Principe Island Puerto Rico Qatar Reunion Romania Russian Federation zone one Russian Federation zone two Russian Federation zone three Russian Federation zone four Russian Federation zone five Russian Federation zone six Russian Federation zone seven Russian Federation zone eight Russian Federation zone nine Russian Federation zone ten Russian Federation zone eleven Rwanda Saba Samoa San Marino Sao Tome e Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Society Island Solomon Islands Somalia South Africa Spain Sri Lanka St Christopher St Croix St Helena St John St Kitts Nevis St Lucia St Maarten St Pierre & Miquelon St Thomas St Vincent Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tuamotu Island Tubuai Island Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom USA Aleutian USA Hawaii USA Alaska USA Pacific USA Mountain USA Arizona USA Central USA Eastern USA Indiana East Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands Wake Island Wales Wallis and Futuna Islands Windward Islands Yemen Yugoslavia Zaire Kinshasa Mbandaka Zaire Kasai Zaire Haut Zaire Zaire Kivu Zaire Shaba Zambia Zimbabwe Emergency Contact Information *Contact name *Emergency Contact Phone number Use xxx-xxx-xxxx format. International applicants, please add country code + before phone number *Gender Male Female *Age Group 18 to 35 36 to 50 51 to 65 65 + Middle Initial (Optional) *On an average, how much time could you devote for GIBV work per month? 5 Hours 6 to 15 Hours 16 to 30 Hours 31 to 60 Hours Other *I will be 5 Driving to Americas Best Value Inn, 485 S. Main St., Milpitas, CA Flying to San Jose Airport Other (If flying, send itinerary to firstname.lastname@example.org once you book the flight.) *I will arrive on Friday. June 8th evening/night Saturday, June 9th by 8:00 AM Other *I will depart on Sunday, June 10 after 9:00 PM Other *Transportation (The Hotel is 8.5 miles from the San Jose airport) I am driving. I have my own transportation I am flying but will have my own transportation to and from the airport. I need help with the transportation to and from the San Jose airport Other Only Vegetarian food will be served. Any Medical/Religious needs/condition that we should know about? (Will be kept confidential.) Registration Fee I am OK with Shared room :$150 Need Single room. Total fee :$300 Your contribution to GIBV is tax deductible. Registration fee of $150 includes all meals (two lunches, two dinners, two breakfasts, afternoon tea and snacks), and stay at the hotel on Friday and Saturday night (two persons sharing a double bed room.) There is no discount for not staying at the hotel.