PRE-REGISTRATION FORM

Name (Last, First)
Organization
Street Address
City
State
Country
Zip or Postal Code
Telephone
Fax
E-Mail Address

Fees (in U.S. dollars):

 

Registration Fee, Regular $80.00

 

Registration Fee, Full Time Student $40.00

 

Breakfast, Wednesday June 2 $5.00

Breakfast, Thursday June 3 $5.00

Breakfast, Friday June 4 $5.00

Lunch, Wednesday June 2 $15.00

Lunch, Thursday June 3 $15.00

Dinner, Wednesday June 2 $20.00

Banquet "The Politics of Religious Liberty," Thursday June 3 $30.00

Dorm Accommodation - Night June 1 $45

Dorm Accommodation - Night June 2 $45

Dorm Accommodation - Night June 3 $45

Dorm Accommodation - Night June 4 $45

Dorm Accommodation - Night June 5 $45

(dorm is optional - see program for hotel recommendations)

Shuttle Service Card (from hotels to conference - 3 days) $30.00

 

          

Total $

 

Tickets for all meals may be pre-purchased with this registration form, or purchased at the conference at least 4 hours before the event while available. Tickets for the field trips to "Father Divine's Pennsylvania" and "The Amish of Lancaster County" may not yet be pre-purchased and should be purchased at the conference (prices to be announced).

 

 

                    Method of Payment

 

             a) Credit Card

Type of Card/Tipo di carta     VISA MasterCard EuroCard

Here are the details of my credit card for immediate on-line registration:
   Name on Card (print)
   Number
01 02 03 04 05 06 07 08 09 10 11 12 1999 2000 2001 2002 2003 Expiration Date
01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Birthdate
Signature:_____________________________

b) I will mail the details of my card with a printed and signed copy of this form

c) I want to register now and am sending a printed and signed copy of this form with a cheque drawn on a U.S. bank ___

d) I want to register now and am sending a printed and signed copy of this form with details of my bank draft ___

If you did not select option (a), send payment and registration forms to:
Bryn Athyn College of the New Church, Attn: Carol Odhner
P.O. Box 740, Swedenborg Library, Bryn Athyn, PA 19009, USA

If you select option (d') send bank drafts as follows:
Name of Bank: First Union National Bank
ABA Number: 031201467
Account Name: The Academy of the New Church
Account Number: 2100010135805
Address: P.O. Box 8209, Philadelphia, PA 19101, USA

             

Programme

Practical Information

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