Name: ___________________________________________________________
Email: ___________________________________________________________
Address: _________________________________________________________
City: ____________________________________________________________
State/Province: ____________________________________________________
Country: _________________________________________________________
Postal Code: ______________________________________________________
Phone Number: ____________________________________________________
Alt Phone/Mobile:___________________________________________________
Lodging:
Unterkunft direkt beim HÖB buchen.
Registration Fee:
(Fees quoted in US dollars) Bitte ankreuzen:
__ $220 - MITGLIEDER
__ $110 - SCHÜLER
__ $320 - NICHT-MITGLIEDER
Bankett-Teilnahme am Sonntag bitte ankreuzen:
__ $36 - per person
TEILNAHME AN EINEM EINZELTAG:
__ $80 - Single day fee for ATI members (one day only permitted at this rate)
WELCHER TAG? ___ MO ___ DI ___ MI
PRE-DAY-TEILNAHME
__ JA. I will be attending the Pre-Day Sponsorship Session. ($10.00)
__ NEIN. I don't plan to attend the Pre-Day Sponsorship Session.
__ WEISS NOCH NICHT. Not sure about attending the Pre-Day Sponsorship Session yet.
__ I am a Sponsor and plan on sponsoring during the Pre-Day Sponsorship Session.
GESAMTSUMME (US$ ONLY) : $___________
BEZAHLINFORMATION:
Paid by: ___ Check/Money Order ( in US$, enclosed) OR
___ Visa ___ MasterCard Card Number: _________________________________
Expiration Date: ___/____/____
Name as it appears on card (please print): _________________________________________________
UNTERSCHRIFT: __________________________________________________________________________
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: alexandertechnique@verizon.net
BITTE EINE KOPIE DIESES ANMELDEFORUMALES MITBRINGEN ZUM AGM