To register for the conference - Print this registration form, fill it and send it to the adderess below.
__ $225.00 Pathologically Early before Aug 16th __ $225.00 Unusually Healthy before Sep 18th
__ $275.00 Chronically late & Walk-Ins after
Sep 18th ___ $180.00 Students (Post raumatic
Academic hock Syndrome)
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Last Name:________________________ First Name:
_____________________________
Address 1:________________________ Address 2: _______________________________
City :____________ State: ______________ Zip Code:_____________
Phone:__________________ FAX:__________
Payment Methods: Please Pay in US Funds
| __Check (payable to BFTC) | ___Money Order | |||
| __Visa | ___Master Card | ____American Express | ||
| Account#__________________ | Exp Date:____________ | Amount ___________ | ||
Registrations received by October 1st will receive
a written confirmation, a map, and other information about the
conference such as parking and shuttle service
Purchase Order Numbers will
not be accepted. Payment
in full must be accompany this registration form.
Cancelation & Refund policy:
Refunds gladly made, less a $30.00 USD processing fee. Request
for refund must be postmarked by October 18, 1996. No refund after
thisd time.
For further information about the confrenence please contact: