Orgone Biophysical Research Lab
Ashland, Oregon, USA Printable Registration Form
OBRL Greensprings Seminars
Please print out the following form, and fax or postal-mail it to OBRL at the address below. Alternatively, provide the same information by ordinary email.
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?
_____ Laboratory Seminar on General Orgonomy, $600
_____ Partial Attendance to Lab Seminar, $150 per day (Please specify which days)
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.
Visa/Mastercard
Expiration date ______________________ 3-Digit Security Code ________
Your Signature ________________________________________________________
If you are not the card-owner, also provide the full name, postal address and telephone number of the card-owner, as on record with the credit card company.
You can also register on-line: Before registering, please review our Seminar Refund Policy.
Send this form or similar information, with payment to:
Number _______________________________________________________________
CLICK HERE FOR ON-LINE REGISTRATION AND PAYMENT
