Name______________________________________________________________________________________
Organization (if applicable)__________________________________________________________________
Address _______________________________________________________________________________
City______________________________________________ State _________Zip______________
Country _______________________________
Email _______________________________
Phone (day)___________________________ (eve)_______________________
Registration Fee (Lunch and dinner included) $275 per person
This registration is for #___________ people for _______________________
__________________________________________________(University/city) on ________________(date)
Payment Method
Check or money order, payable to School of Metaphysics
Credit Card: Visa MasterCard Discover
Card # __________________________________________
Exp. Date ________________
Signature ____________________________________________________
Would you like to receive information about accomodations? yes no
Will you be applying for Continuing Education Units in your professional field?
yes no
You will receive confirmation of your registration within 10 days of receipt. We look forward to meeting you. If we can be of further service to you please contact the host branch of SOM or our headquarters at powersoften@som.org