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Registration Form
June 10-12, 2005 ~ Hilton Resort & Spa ~ Sedona, AZ

"Living a Technicolor Life"

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Registration Form for Mail or Fax

Please check all that apply to your registration(s):

  Full Conference Pass $295 (if received by Dec. 30 2004)
  Full Conference Pass $325 (if received Dec. 31 2004 or after)
  $295 per person through March 1, 2005 (Group of 6 or more) - one fully completed registration form per person is required - all registrations must be submitted at the same time with full payment for all of them.
  Exhibitor's Registration $495 (includes one Full Conference Pass at a 10% discount)
  Special Donor Offer $500 (A Full Conference Pass at $250/ea. for you and someone we select)
  Scholarship Contribution Amount $________ (additional to your own Full Conference Pass payment.)

Note: The date your registration is received in our office determines the registration date.

Full Name___________________________________________________

Address_____________________________________________________

City/State/Zip_______________________________________________

Day Phone:___________________ Evening Phone:__________________

Mobile Phone:__________________Pager:_________________________

Email Address:_______________________________________________

This registration is for group member #______ of ______ (total)

I'm paying by: □ Check □ Money Order □ Traveler's Check

□ Visa □ MasterCard □ Discover □ American Express

Name as it appears on card:____________________________________

Account #_____________________________________ Exp:_________

Your Signature authorizing payment using the above card:

___________________________________________________________


Click Here to Pre-Register !

A Service of Positive Life Worksâ„

"In the century now dawning, spirituality, visionary consciousness, and the ability to build and mend human relationships will be more important for the fate and safety of this nation than our capacity to forcefully subdue an enemy. Creating the world we want is a much more subtle but more powerful mode of operation than destroying the one we don't want." ~ Marianne Williamson