THIS IS NOT AN ONLINE REGISTRATION FORM - FOR PRINT ONLY            Printed Date: 4/19/2024 4:55:20 AM
Seminar Title:
 5-Day Yoga and Meditation Retreat for Mental Health Professionals
Seminar Date:
Wednesday, October 7, 2020
Seminar Location:
BOONE, NC 28607
Seminar ID:
80913
  Required (select one)
 
EARLY BIRD REGISTRATIONS AVAILABLE THROUGH AUGUST 7, 2020


Before August 7, 2020
    $2,399.00 Registration: HOTEL Style - Single Occupancy
    $2,199.00 Registration: HOTEL Style - Double Occupancy
    $1,999.00 Registration: RETREAT Style - Single Occupancy
    $1,799.00 Registration: RETREAT Style - Double Occupancy

After August 7, 2020
    $2,599.00 Registration: HOTEL Style - Single Occupancy
    $2,399.00 Registration: HOTEL Style - Double Occupancy
    $2,199.00 Registration: RETREAT Style - Single Occupancy
    $1,999.00 Registration: RETREAT Style - Double Occupancy
  ________ HI, NM attendees add applicable sales and local taxes**
  ________ Subtotal (Required items + sales tax)
   
  ________ Total (Required subtotal + Optional subtotal)
  *** Registration for coordinator or military member discount must be completed online
  **** All prices are shown in US Dollars ****
 
 

Please enter the MAIL CODE in the box below.

If you have a brochure, this code is found on the
back in the box above the address block.

If you do not have a brochure, please enter 888.

Mailcode Example
Mail Code or VIP #:
 *  
First Name:
 *     Last Name: *
Profession:
 *
  Note: Leave Company/Department blank if providing home address
Company Name:
 *
Department:
 *
Address:
 *
City:
 *    State: *    Zip: *    County: *
Work Phone:
 *      Cell Phone:   *      Fax Number:  
Email Address:
 *    License Number: *
(required for confirmation of registration)
  Prepayment is REQUIRED
  Check enclosed
  Signed Purchase Order enclosed
Credit Card Type:
 Mastercard    Visa    Amex    Discover
Credit Card #:
   V-Code #*
Exp Date:
/ *MC/Visa/Discover: last 3-digit # on signature panel on back of card
*American Express: 4-digit # above account # on face of card
Name on Card:
Mail or Fax to:
PESI, P.O. Box 1000, Eau Claire, WI 54702-1000      (800) 554-9775 (fax number)