Online Conference Registration Form - Brugh Joy, Inc.
Use your TAB key to proceed to the next box. Please fill in all applicable information.
Conference
Select Conference LP-10: Lone Pine Retreat; October 27 - November 2, 2008 HB-5: Heart Beat, June 14 - 21, 2008 HB-6: Heart Beat, June 24 - July 1, 2008 HB-8: Heart Beat, October 11 - 18, 2008 IN-138: Foundational Conference, December 3 - 14, 2008
First Name:
Last Name:
E-mail Address:
Website:
Home Phone:
Work Phone:
Cell Phone:
Fax:
Mailing Address:
City:
State:
none ALAKAZ ARCACZ COCTDE DCFLGA GUHIID ILINIA KSKYLA MEMDMA MIMNMS MOMTNE NVNHNJ NMNYNC NDOHOK ORPAPR RISCSD TNTXUT VTVIVA WAWVWI WY
Zip:
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Emergency Contact
Name
Phone
Birthdate
Gender
Male Female Select
Smoker
No Yes
Diet
No Restrictions Vegetarian Other
If you have allergies or medical conditions, etc., please explain:
In some conferences breakfast is self-prepared.
Are there any foods you prefer to have available for breakfast?
Other special needs (such as medical):
Room Preference (shared or private)
Payment policy The deposit due at the time of registration is 50%, with the remaining 50% due 2 weeks prior to conference start. The deposit for Joy's Jubilation is 25% of total tuition, which is the full amount for the first session. Please note our strict cancellation policy: Your deposit is non-refundable unless someone takes your place. If someone does take your place, your deposit is returned to you minus a $300 administration fee for 9 to 12-day conferences and $150 for 3 to 7-day conferences, plus any room and meal charges not refunded to us by the conference center. This strict policy ensures your space at the conference facility. Please call the office at 800-448-9187 if you would like further information.
Please choose form of payment:
Choose One Credit Card Check
To pay by check, submit form below and mail your check for 50% of the conference tuition within 5 days. Make checks payable and send to: Brugh Joy, Inc. P. O. Box H (eart) Marysville, CA 95901 To pay by Visa or MasterCard continue online after submitting this form. We will charge your credit card 50%* of the conference tuition now and the final 50% two weeks before the conference begins, unless other arrangements are made through our office. *Joy's Jubilation deposit is 25% of total tuition.
Please do not click the Submit Form button unless you intend to register for a conference. You will receive a letter of confirmation once your deposit has been processed.Thank You!
