PRINT

Praxis Peace Institute - Registration Form – Dubrovnik Conference
Sunday, June 3 to Saturday, June 9, 2007


NAME___________________________________________________

ORGANIZATION___________________________________________

ADDRESS__________________________________________________

CITY____________________________ State______________ Zip_____

PHONE_________________________

E-MAIL____________________________________________________

PLEASE CHECK PACKAGE OPTION:
Special Discount: Deduct $100 if you are registering before Dec. 15, 2006. (Offer available for the first 30 sign-ups only).

A. SEA VIEW, SINGLE - $2,300__________

B. SEA VIEW, DOUBLE - $1,800___________

C. PARK VIEW, SINGLE - $2,100___________

D. PARK VIEW, DOUBLE - $1,650___________

YOUTH PACKAGE, DOUBLE - $1,550 (25 or under)_______
(Early Discount does not apply to youth package)

If choosing a Double Room, please supply Name of Roommate:

_______________________________________________

If you are seeking a roommate, please call our office - 707-939-2973, and we will try to accommodate your needs.

I prefer
Vegetarian meals____Vegetarian with Fish_____ Meat_________

Payment Options:

VISA________MASTERCARD_______CHECK______(checks save us money in bank fees.)

Amount___________________

Credit Card Number_________________________________________

Expiration Date________________________

Signature__________________________________________________


Checks should be made payable to Praxis Peace Institute and sent to:
Praxis Peace Institute, P.O. Box 523, Sonoma, CA 95476 * or fax: 707-939-6720
Tel: 707-939-2973 – www.praxispeace.org