CONFERENCE REGISTRATION FORM

“The Alchemy of Democracy, Restoring Soul to Culture”

June 13 – 18, 2004, Asilomar Conference Grounds, Pacific Grove, CA

$100. Discount is extended to March 10, 2004!

CEUs available for conference participation

________I am registering for the Conference by March 10, 2004. Fee is $595.

________Regular conference registration - $695. (after March 10, 2004)

________I am registering as a Youth (age 25 or younger) - Rate: $495.

Conference Fee includes costs for all conference sessions and day-long workshops.

IMPORTANT NOTE: After registering for the conference, you will receive the Praxis Group Code for making reservations at Asilomar.

Send to: Praxis Peace Institute, P.O. Box 523, Sonoma, CA 95476

Tel: 707-939-2973 * Fax: 707-939-6720

Name Please Print Clearly

Address

City State Zip

Tel Fax

E-Mail (Please Print VERY clearly)

Payment Options: _______Check _______Visa ______MasterCard

Credit Card Number

Expiration Date

_____________________________________________________________________________

Signature

Each applicant should send a separate registration form.

Please assist deserving scholarship applicants to attend this conference. I wish to give a

Tax-deductible donation to the Praxis conference Scholarship Fund for $________

Cancellation and Refund Policy

Refunds for cancellations will be issued as follows:

• Full refund, minus $75.00 processing fee, to March 1, 2004

• 90 days prior to the conference – 80% refund

• 60 days prior to the conference – 70% refund

• 30 days prior to the conference – 50% refund

• 15 days prior to conference – no refund

Travel to Pacific Grove, CA

• Pacific Grove is located on the Monterey Peninsula in central California. Air travel is accessible through the Monterey Airport (with connections coming through San Francisco or Los Angeles first) or through the San Jose Airport. Driving time is approximately 2 hours from San Francisco, 1-1/2 hours from San Jose, and 5-1/2 hours from Los Angeles.