Second International Congress on Tibetan Medicine
November 5 - 8, 2003

Hyatt Regency, Capitol Hill, Washington DC

REGISTRATION FORM

Name: Last Name: Credentials:

Mailing Address:

City: State: Zip:

Country:

Phone: Fax: Email:

 Check here if, under the Americans with Disabilities Act, you need special seating arrangements because of hearing, visual or mobility impairments

Conference Fees: November 5-8, 2003 (Includes all events from Wednesday evening through Saturday evening with Sogyal Rinpoche). Please check one box

Sogyal Rinpoche – Saturday Nov. 8, 2003  (Includes entire day)

Total of Payment:

Method of Payment:      MasterCard                 Visa

Credit Card Number: Expiration Date:

Name of Card Holder:

Cancellation Policy:
All cancellation requests must be made in writing. No phone cancellations will be honored. A full refund minus a $50 processing fee will be made for each request postmarked by October 27, 2003. No refunds will be made for requests postmarked after October27, 2003. All refunds will be issued after the conclusion of the conference. Please send your written request to Pro-Cultura, Inc., P.O. Box # 185, Pleasantville, NY 10570.