Hatun Karpay, Peru
July 3-15, or September 30 through October 12, 2006

REGISTRATION FORM
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Please type or print clearly and mail or fax to the address below with your deposit. 

The Center of Light, Vermont

HATUN KARPAY WITH JUAN NUNEZ DEL PADO

July 3-15, or September 30 - October 12, 2006  (circle one)

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)

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