CONFERENCE ATTENDEE REGISTRATION FORM
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 www.intestinalhealth.org/Taosevent
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
SPECIAL NEW MEXICO DISCOUNTS!
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:
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.
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.