Telecosm 2004 Registration Form

The 8th Annual Gilder / Forbes Telecosm Conference
October 19 - October 20
The Resort at Squaw Creek, Lake Tahoe, California

If you would like to attend the upcoming Gilder/Forbes Telecosm conference please complete and submit the following via mail or fax. Fax: (413)644-2122 Gilder Publishing, LLC 291A Main St. Great Barrington, MA 01230
1. Contact Information
Salutation	Mr. Mrs. Ms. Dr.
Full Name	_________________________________________________
Title	_________________________________________________
Company	_________________________________________________
Street	_________________________________________________
City, State, Zip	_________________________________________________
Country	_________________________________________________
Email	_________________________________________________
Phone	_________________________________________________
Fax	_________________________________________________
Business Assistant	_________________________________________________
Phone	_________________________________________________
email	_________________________________________________
2. Supply Method of Payment (Payments will only be processed on approved applications). GTR, Forbes, and Gilder Friday Letter and Storewidth.com subscribers qualify for OVER 50% OFF the conference list price of $2,995. I am a subscriber and understand that I am committing to attending this conference with my payment of $1,495.00
Credit Card	Amex Visa Mastercard
Card Number:	_________________________________________________
Expiration Date:	_________________________________________________
Cancellation Policy Cancellations received in writing (a faxed letter is acceptable) by September 17, 2004, will be honored with a full refund of the conference registration fee. Cancellations after September 17, 2004 will not be honored with a refund. A substitute from the same organization may take the place of a registered attendee, or the conference registration fee may be applied to another conference hosted by Gilder Publishing, in connection with Forbes Inc., within one year of the date of the conference to which registrant was originally registered. Yes, I have read and understand the Gilder/Forbes conference cancellation policy.