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:

SUMMER SEMINAR: 29-30 AUGUST 2015, ASHLAND OREGON
_____________________________________________________________________________

How Many Persons will you be paying for?

Payment by Check/Money Order send by postal mail, made out to "James DeMeo".

For Visa/Mastercard payment, use our on-line registration page (link below) using the PayPal system -- they accept your credit card even if not a PayPal member.

Alternatively, provide your credit card details on this paper form. Send by postal mail or an image by ordinary email to the address below.

Visa/Mastercard only:
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.

PO Box 1148
Ashland, Oregon 97520 USA
Phone: (541) 552-0118
E-mail to: info(at)orgonelab.org

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