The Center of Light, Vermont HATUN KARPAY
WITH JUAN NUNEZ DEL PRADO July 3-15, or September 30-October 12, 2006 Indicate July _________ or
September/October ________ REGISTRATION
FORM
NAME
(as it appears on passport)
___________________________________________________________
STREET
ADDRESS_______________________________________________________ CITY___________________________________________________________________ TELEPHONE
()
__________________________ (h.) () ________________________________(o.)
___________________________(cell) ()
______________________ (fax)E-MAIL
ADDRESS___________________________________________ PASSPORT
NUMBER ________________________________ EXPIRATION DATE_______________ BIRTHDATE
(required by Peruvian law for hotel
reservations) _________________ PERSON TO BE NOTIFIED IN CASE OF
EMERGENCY : NAME____________________________________________ ADDRESS_________________________________________________ TELEPHONE
() ___________(h.)
______________(o.)
________________(cell) My
$ deposit for registration in this program is enclosed. Please mail
to: The
Center of
Light Zacciah Blackburn