Registration Form for The Science & Spirit of Sound 2005
Second Annual NESHRI Conference
First Churches, Northampton, MA
June 24-26, 2005
We
Accept: 
, debit or credit cards, checks
and money orders,
for all programs and services
The Center of Light Home Page
, debit or credit cards, checks
and money orders,
for all programs and services
The Center of Light Home Page
E-mail: info@sunreed.com
-------------------------------------------------------------------------------------------------------------------------------------
With my signature I acknowledge and accept the conditions of this workshop & registration as set
forth in the information pages contained in The Center of Light's Registration web pages.
Name
...............................................................................................................................................
Address .........................................................................................................................................
Telephone/Fax …………………………………………………………………………………….................
E-mail Address .........…………………………………………...........................................................
cost cost days here
Do you wish to volunteer?....................... Where did you here about the conference? (Please be as specific as you can.) ...............................................
........................................................................................................................................................................................................................
Enclosed is .................................... for payment in full (Please make checks payable to NESHRI)
or, charge to my credit/debit card, this amount ........................................ for payment in full. (All funds in US Dollars)
Address .........................................................................................................................................
Telephone/Fax …………………………………………………………………………………….................
E-mail Address .........…………………………………………...........................................................
Conference
Fees:
in the last box please indicate your choice of full conference or specific
days with dollar amount and total amount at the bottom
members
non-members
your choice ofin the last box please indicate your choice of full conference or specific
days with dollar amount and total amount at the bottom
cost cost days here
Do you wish to volunteer?....................... Where did you here about the conference? (Please be as specific as you can.) ...............................................
........................................................................................................................................................................................................................
Enclosed is .................................... for payment in full (Please make checks payable to NESHRI)
or, charge to my credit/debit card, this amount ........................................ for payment in full. (All funds in US Dollars)
For
Credit/Debit Card Payment (MC, VISA,
or AmEx only): mail, fax or call
with card #, expiration date, name on the card, and your billing address for the card.
with card #, expiration date, name on the card, and your billing address for the card.
Card
Number
....................................................................
Ex Date:
................................
If different:
Name on Card: .................................................... Billing address: ...................................................
................................................................................................
Date ………………………………… Signature..........................................................
To register on line, go to our Secure page, and fill in the Neshri Conference on the
"instruments' line (no other fees apply on the secure order form.)
NESHRI holds it's non-profit status as a project of the Spectrum Arts and Education for Peace, Inc.
If you wish to make a tax-exempt donation to our work, please indicate how much. We will forward a
receipt for this, and we thank you! _____________________________________
If different:
Name on Card: .................................................... Billing address: ...................................................
................................................................................................
Date ………………………………… Signature..........................................................
To register on line, go to our Secure page, and fill in the Neshri Conference on the
"instruments' line (no other fees apply on the secure order form.)
NESHRI holds it's non-profit status as a project of the Spectrum Arts and Education for Peace, Inc.
If you wish to make a tax-exempt donation to our work, please indicate how much. We will forward a
receipt for this, and we thank you! _____________________________________
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Center of Light
Home Page
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of Page
The Center of Light in Vermont
Zacciah Blackburn, 220 Hidden Glen Rd. , P.O. Box 389 , Ascutney, VT 05030 USA
Phone & Fax: (802) 674-9585 E-Mail info@sunreed.com C 2005 Zacciah, The Center of Light
The Center of Light in Vermont
Zacciah Blackburn, 220 Hidden Glen Rd. , P.O. Box 389 , Ascutney, VT 05030 USA
Phone & Fax: (802) 674-9585 E-Mail info@sunreed.com C 2005 Zacciah, The Center of Light