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Name: ___________________________________________________________
Email: ___________________________________________________________
Address: _________________________________________________________
City: ____________________________________________________________
State/Province: ____________________________________________________
Country: _________________________________________________________
Postal Code: ______________________________________________________
Phone Number: ____________________________________________________
Alt Phone/Mobile:___________________________________________________
Room & Board for AGM participants:
The AGM registration fee does not include meals. All meals will be "on your own" as there is no meal plan for this AGM. ( If you choose to attend the Banquet, there is a separate fee and pre-registration as it is a catered , optional event . Stay tuned for more information about registration and fee for the Banquet. ).
AGM Lodging Information
I will be staying at: ___ International Hotel au Lac ___ Elsewhere
Registration Category
AGM Conference Registration Fee (please check one) :
__ ATI Members, paid by July 31 $135.00
__ ATI Members, paid after July 31 $165.00
__ ATI Trainee Members, paid by July 31 $ 50.00
__ ATI Trainee Members, paid after July 31 $ 65.00
__ Non-Members, paid by July 31 $170.00
__ Non-Members, paid after July 31 $220.00
__ Daily Fee for single drop-in attendee $ 50.00 per day (a single day only)
If attending for a single day, which day? ___ Thursday ___ Friday ___ Saturday ___ Sunday
Total Payment (US$ ONLY) : $___________
You can register online and pay by credit card at www.ati-net.com/agm.
If you register online, you do not need to send in this registration form.
Paid by: ___ Check/Money Order ( in US$, enclosed) OR
___ Visa ___ MasterCard Card Number: _________________________________
Expiration Date: ___/____/____
Name as it appears on card (please print): _________________________________________________
Signature: __________________________________________________________________________
Mail with your check, money order in US dollars, or credit card information to :
Alexander Technique International
Main Office
1692 Massachusetts Ave., 3rd Floor
Cambridge, MA 02138 USA
Fax ( CREDIT CARD PAYMENT ONLY): 617-497-2615
Questions: 1-888-668-8996 (toll-free in USA) or 617-497-5151 or email: ati-usa@ati-net.com
Please bring a copy of your registration form with you for confirmation purposes
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