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 at: PO Box 1738, Sedona, AZ 86339.  We prefer payment by check but we also accept Visa, Master Card or Discover Card.   No American Express.

Address:____________________________________________________________

City/State/Zip:______________________________________________________

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

E-mail address:______________________________________________________

Enter below How many "Advance" 3-Day Passes you want.

_____    Each Advance 3-Day Pass  =  $285 

_____    Each Advance 3-Day VIP Pass = $325 (= with VIP seating)

_____      Friday Only Pass (B Marciniak & Whitley Strieber) = $140

_______ Friday, 2-5pm Institute with Barbara Marciniak = $50

_______ Monday, 9am-12  Institute with Andrew Collins = $50

______   Saturday Evening Keynote (Marciniak) Only = $50

$___________    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.

Visa:________Mastercard:_________Discover:_________

Card No :____________   ___________   ____________   ____________

Exp. Date:___________Signature:__________________________