Registration Form: Fax or Mail
Fax: 732-352-6818; Mail:
ICSA, P.O. Box 2265, Bonita Springs, FL 34133 (USA)
Registration Form
Enter below the number of
people and appropriate amounts for registration fees and meals (reserve sleeping
rooms here). All fees are per
person. Full-time students may take the indicated discount (include
photocopy of student ID with registration). Please pay in U.S. dollars drawn
on a U.S. bank, with an international money order in U.S. dollars, or Visa or
MasterCard. Your contributions will help ex-members/students needing financial
assistance to attend. See discount columns for early registration
fees. Don't forget credit card information at the bottom. Fax, mail, or e-mail
this form to International Cultic Studies Association (ICSA), P.O. Box 2265,
Bonita Springs, FL 34133 (fax: 732-352-6818; e-mail: mail@icsamail.org).
Conference programs begin promptly at 9:00 A.M. for Friday and Saturday, 10:00
A.M. for Thursday workshops. Evenings are free for socializing or optional
programs. Arrive at least 30 minutes early for registration. Full refund up to
30 days prior to conference; partial refund thereafter (contact ICSA). The
conference program is subject to change.
|
No. People |
Item |
Register by
Mar. 1, 2006 |
Register by April 15,
2006 |
Register After April
15, 2006 |
Calculate Amount Due |
|
|
Thursday family
workshop (10-5:30) |
$50 |
$65 |
$80 |
$ |
|
|
Thursday ex-member
workshop (10-5:30) |
$40 |
$55 |
$70 |
$ |
|
|
Thursday born or
raised session (7:30 – 9:00) |
Free to registrants.
Born or raised only. |
$ |
|
|
Thursday mental
health workshop (7:30 – 9:00) |
Free to registrants and M.H.
professionals. |
$ |
|
|
Registration
Friday and Saturday |
$140 |
$180 |
$200 |
$ |
|
|
One-Day
Registration. Check Day:
Fr. [ ] Sat. [ ] |
$80 |
$100 |
$110 |
$ |
|
|
Full-Time Student
Rate Check Day(s): Th. Family
[ ] Th. Ex [ ] Fr. [ ] Sat. [ ] |
$25 per day |
$ |
|
Meal Options. |
Thursday |
Friday |
Saturday |
|
|
|
Breakfast ($13 each)
: |
$ |
$ |
$ |
$ |
|
|
Lunch ($13 each) |
$ |
* $ |
* $ |
$ |
|
|
Dinner ($23 each) |
$ |
* $ |
* $ |
$ |
|
* Indicates there
will be a dinner or luncheon speaker |
|
Contribution |
$ |
|
Total Amount |
$ |
|
Payment Method:
_____Check (U.S. Funds drawn on
U.S. bank or money order)
___Visa ___ MasterCard
Number:
Exp. Date: |
|
Name: |
|
Address: |
|
Address (Cont.): |
|
City/State/Zip/Country: |
|
Phone(s)/Fax: |
|
E-Mail (Important!): |
|
|
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