Attendee Registration Form

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On-Line Registration (preferred with Credit Card) Fax to: (214) 341-95229522 (with Credit Card) or Mail with Check to: IHI, Conference Registration 10875 Plano Rd., Suite 123, Dallas, TX 75238 See Conference Information at
This form is for Conference Attendee Registration To register more than one person, please copy this form and fill out a form for each person and fax to (214) 341-9522. To register by telephone, please call (804) 247-1655. Please check one of the following: Full Conference Program and Meals ............... _______ Friday Only Program and Meals ...................... _______ Saturday Only Program and Meals ................... _______ Sunday Only Program and Meals .................... _______ Additional Welcome Reception Ticket(s) .......... _______ Additional Banquet Ticket(s) ............................ _______ I am a: ____ Doctor ____ Other Health Professional

Full Conference Program & Meals (April 3 - 6, 2008) Friday only Program & Meals (April 4, 2008) Saturday only Program & Meals (April 5, 2008) Sunday only Program & Meal (April 6, 2008) $300.00 $100.00 $150.00 $ 50.00

Additional Ticket Fees Thursday, April 4, 2008 Welcome Reception - $45.00 Saturday, April 6, 2008 Banquet - $60.00

____ IHI Client Last Name:

____ Other: __________________________

First Name: Address: City: State:

Zip Code:


Email Address (required for confirmation): ____Please provide me a vegetarian meal for the Saturday night dinner. ____Please provide me with kosher meals. Note: By providing your e-mail, you grant IHI permission to contact you via e-mail regarding your registration and updates on the "The Higher Truth of Health" Conference. Name of person who contacted me: Method of payment: ___Master Card ___Visa ____Check or money order enclosed (Please make payable to: Intestinal Health Institute in U.S. dollars drawn on U.S. bank.) Credit Card Number: Name On Card: Signature: Total Amount Due: $ PLEASE NOTE: Registration will not be processed without payment or if submitted with declined or invalid credit cards. COURTESY NOTE: “The Higher Truth of Health” is a non-smoking conference. Also, out of respect for our chemically sensitive patrons, we ask that no perfume, cologne, hair spray or other perfumed products be worn at the conference. Thank you.
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Exp Date:

3 Digit SSV Code: Billing Zip Code: Date:

REFUND POLICY: Refunds (less a $50.00 processing fee) will be given to registrants who cancel by 5:00 p.m. on Friday, March 14, 2008. No refunds will be made after that time. DISABILITY ARRANGEMENTS: If special arrangements are required for anyone with a disability, please contact us at (804) 247-1655. NOTE: You may transfer your registration to another person at any time.

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