Greensprings Center, PO Box 1148
Ashland, Oregon 97520 USA
Phone/Fax: (541) 552-0118
E-mail to: info(at)orgonelab.org
(Click or copy into your email program and insert the "@" symbol)
http://www.orgonelab.org/events.htm
Printable Registration Form
Summer Laboratory Seminar on General Orgonomy
Please print out the following form, and fax or postal-mail it to OBRL at the address below. Your Name ___________________________________________________________________
Spouse or Guests? ___________________________________________________________
Address _____________________________________________________________________
_____________________________________________________________________________
City/State/Zip ______________________________________________________________
Telephone/Fax _______________________________________________________________
E-mail __________________________________
Please identify the Title and Date of the Seminar Event you wish to attend:
_____________________________________________________________________________
How Many Persons will you be paying for?
_____ Persons - Full Registration 5-days $750
_____ Persons - Student Registration $500 (photocopy of student ID requried)
_____ Person/Days - Partial Registration $175 per day per person
Visa/Mastercard
Expiration date ______________________ 3-Digit Security Code ________
Your Signature ________________________________________________________
You can also register on-line: Before registering, please review our Seminar Refund Policy.
Send this form or similar information, with payment to:
Alternatively, provide the same information by ordinary email.
Payment by Check/Money Order (send by postal mail) or Visa/Mastercard (send by postal mail, fax, or ordinary email). Make checks out to "James DeMeo". Credit Card payments will appear on your card under the name "Natural Energy Works" which is our mail-order charge account.
Number _______________________________________________________________
CLICK HERE FOR ON-LINE REGISTRATION AND PAYMENT