Praxis Peace Institute - Registration Form - Dubrovnik 2002

NAME:___________________________________________________

ORGANIZATION:___________________________________________

ADDRESS:__________________________________________________

CITY:__________________________________ State:______________ Zip:_____

PHONE:_________________________FAX:________________________

E-MAIL:____________________________________________________

PLEASE CHECK PACKAGE OPTION:

A. SEA VIEW, SINGLE - $1,850.__________

B. SEA VIEW, DOUBLE - $1,650.___________

C. PARK VIEW, SINGLE - $1,650.___________

D. PARK VIEW, DOUBLE - $1,450.___________

YOUTH PACKAGE, DOUBLE - $1,350.___________

If choosing a Double Room, please supply Name of Roommate:

_______________________________________________

If you are seeking a roommate, please call our office - 707-939-2973,
and we will try to accommodate your needs.

I prefer

Vegetarian meals_______ Vegetarian with Fish_________ Meat meals__________

Payment Options:

VISA________MASTERCARD_______CHECK______

Amount___________________

Credit Card Number_________________________________________

Expiration Date________________________

Signature__________________________________________________

Checks should be made payable to Praxis Peace Institute

Please send this form with your payment to:

Praxis Peace Institute
P.O. Box 523
Sonoma, CA 95476
Tel: 707-939-2973
Or, fax registration form to Fax: 707-939-6720
Email: praxispeace@aol.com

The Dubrovnik Conference is sponsored by Praxis Peace Institute, a peace education organization.
Praxis Peace Institute is a non-for-profit 501(c) (3) corp. (tax ID # 68-0450856).