SECURE ONLINE REGISTRATION

Archetypes and Shadows
The Invisibles that Run or Ruin Your Life



February 28-March 6, 2003
Dahlonega, Georgia


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Name (First and Last):
(If you are paying for more than one person, please fill out a separate form for each attendee. Thanks!)
Mailing Address:
(include apartment numbers or suite numbers)
City: State:
Zip/PostalCode: Country:
Home Telephone (w/ area code):
Work Telephone (w/ area code):
Email Address:
VERY IMPORTANT!
Payment Method: (Discover Card preferred, if you have one!)
Credit Card Number:
Expiration Date:
Authorized Amount:

Additional Comments:


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By pressing the "send" button, you are authorizing Eupsychia Institute to charge your Credit Card the amount you have indicated above...



Pressing "send" will now send you to a form requiring you to submit your
preferences to us about lodging, roommate, diet, and more.

•••••

THANKS! WE LOOK FORWARD TO BEING WITH YOU!

(You may also register by phone toll-free 1-800-546-2795 or mailing a check to:
Eupsychia Institute, Attn: March 6-Day, PO Box 151960, Austin, TX 78715-1960. Fax (512) 327-6043

 

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