To register, PRINT this form and either FAX it to Dr. Chet Snow at:  (928) 204-1955 or MAIL it with your check to Dr. Chet Snow - PO Box 1738 -  Sedona, AZ 86339.    We prefer payment by check but accept Visa, MasterCard or Discover-Card & Pay Pal.   No American Express, except via Pay Pal.

Name:____________________________________________________  

Address:_________________________________________________________

City/State/Zip:____________________________________________________

Phone: (______) _________ _________Your Fax: (______) ______ ________

E-mail address:___________________________________________________

Enter below how many Advance Passes you want. Valid to November 14

_____   2011 "Advance 3-Day Pass"  =  $299

_____  2011  "Advance 3-Day VIP Pass" = $340
                                (VIP seating, Rows 1-3)
_____  2011 "Advance VIP Package Pass"  = $375
                     (Includes JJ & Desiree Hurtak Friday Institute)

_____ Friday, 2-5pm, Institute with JJ & Desiree HURTAK = $65

$___________    Total AMOUNT, either by check or by credit card.
              Please, make all checks payable to:  "Dr. Chet Snow"

Credit card payments MUST include your home telephone number.

Visa:________  Mastercard:_________Discover:_________

Card No :____________   ___________   ____________   ____________

Exp. Date:___________  Signature:__________________________