Printable Registration Form

Summer Laboratory Seminar on General Orgonomy

More information on this Seminar can be found at:
http://www.orgonelab.org/events.htm


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?

_____ Persons - Full Registration 5-days $750

_____ Persons - Student Registration $500 (photocopy of student ID requried)

_____ Person/Days - Partial Registration $175 per day per person


Total Registration Fees Due: _______________


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
Number _______________________________________________________________

Expiration date ______________________ 3-Digit Security Code ________

Your Signature ________________________________________________________

You can also register on-line:
CLICK HERE FOR ON-LINE REGISTRATION AND PAYMENT

Before registering, please review our Seminar Refund Policy.

Send this form or similar information, with payment to:

Orgone Biophysical Research Laboratory, Inc.
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)

More information on this Seminar can be found at:
http://www.orgonelab.org/events.htm