Daniel Clark, MD,
WM Lee Cowden & Pure Vitality, Inc.
Presents
The 11th International Congress Of BioEnergetic Medicine
September 6-9, 2007
ELECTRONIC REGISTRATION FORM
24 CME’s Approved and 24 CEU’s Applied For
Attendee #1 Degree
Attendee #2 Degree
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  Professionals::
3.5 DAYS early registration (before August 1st)............$ 450

3.5 DAYS regular registration ................................ $ 475
Thursday Only.......................................................$150

FRIDAY only .......................................................$ 150
SATURDAY only...................................................$ 150
SUNDAY only......................................................$ 150
   
 

Student, Assistant, Spouse :

3.5 DAYS early registration (before August 1st)............$ 375

3.5 DAYS regular registration ................................ $ 400
Thursday Only.......................................................$125

FRIDAY only .......................................................$ 125
SATURDAY only...................................................$ 125
SUNDAY only......................................................$ 125
   
Vendor Hall - $75/day
 

Mid-morning & afternoon Refreshments are included, as well as a Saturday night Wine/Beer Reception.
 

Ask for "The 11th International Congress Of BioEnergetic Medicine" room rates -$145(limited supply)
   
 

Type of Payment: Visa MasterCard Cash/Check (write check to Daniel Clark MD/DGC03)
   
 

Credit Card No. Exp. Date (mm/yyyy) Security code

   
 

Signature:__________________________________________________(required)

 

Please Fax to 561.526.1005
 


or mail to: Dan Clark, MD 2175 S. Ocean Blvd #106Delray Beach Fl, 33483

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