Jain Digest 2005 11

Author(s): Federation of JAINA
Publisher: USA Federation of JAINA

Page 27

Registration Form
Phone:
Email:
JULY 1-4, 2005
San Francisco Bay Area, California USA
1
REGISTRATION FORM
If you have access to internet, please register online at www.jaina.org, then no need to mail paper form STEP 1: CONTACT INFORMATION: This information must be completed in order to receive your registration confirmation. Primary Registrant Name:
Name of your Jain Center:
Address: Street/Apt#
State/Province
Emergency Contact:
STEP 2: INDIVIDUAL REGISTRATION FEES:
CHILDREN UNDER 6 Free
CHILDREN (AGE 6 UP TO AGE 17)
ADULTS (AGE 18 & UP)
STEP 3: CONVENTION REGISTRATION
2
3
4
5
6
Last Name
Primary Registrant:
JAINA
T
Extending Jain Heritage in Western Environment
First Name
Mail registration form and check to:
JAINA CONVENTION 2005
PO BOX 630
Cupertino, CA 95015-0630
U.S.A
To 1/31/05
2/1-4/15/05
4/16-6/15/05
US$ 69
US$ 79
US$ 59 US$ 109 US$ 129 US$ 149 Please list all attendees including infants.
Postal Zip code Cell:
Sex M/F
EMAIL: registration2005@jaina.org
PHONE: +1.408.946.5246
Individual Age Registration Fee (from Step 2)
Please make your check or bank draft payable in (US$) to: JAINA CONVENTION 2005
Room (per night) + Tax* 79+7.54 (US$ 86.54) 79+7.54 (US$ 86.54)
2005
No. of attendees requesting VEGAN food for all four days STEP 4: HOTEL REGISTRATION (Please see Terms & Conditions. Convention Hotel Preference (1-Highest, 3-Lowest): Westin (Convention Center hotel). Hilton Check-in Date: Check-out Date: Smoking
Room Type
No. of room(s) w/ 1 King Bed
Yes No
No. of room(s) w/ 2 Double Beds Hotel Room Tax is estimated Step 5: OPTIONAL TOUR REGISTRATION Amount from the backside of the Form Please Donate (tax deductible) generously to make the Convention successful
6/16-7/04/05 US$ 89 US$ 159
Charge my:
Optional Social Activities # 1 Age 14 to 17 US$30/pp
13TH BIENNIAL JAINA CONVENTION Extending Jain Heritage in Western Environment
City
MasterCard
Country/Region
Fax:
Phone:
LULU
Postmark of registration form will determine applicable registration fees.
Basic Registration Sub-Total (A) US $ Child Care needed (only potty trained) registration required for hotel registration)
Optional Social Activities # 2 Age 18 to 35 US$50/pp
JAINA
Networking Forum (JNF)* Age 21 to 40 US$75/pp
(across Convention Center). Marriott (1 mile away) 2nd & subsequent nights hotel payments to be made at checkout No. of Rooms 1st Night Deposit: US$ 86.54 x No of Rooms
1st Night Hotel Deposit Sub-Total (B) US $
Tour Sub-Total (C) US $ Donation Amount (D) US $ Total (A+B+C+D) US $
PAYMENT MUST BE MADE IN US DOLLARS ONLY. Charge my CREDIT CARD below. I accept all the Terms & Conditions on this form. Total Amount Enclosed: US$
VISA
Sub-Total
Discover
Exp. Date:
(mm/yy)
CW Code:
L (Last 3 numbers on back of card) Name of Cardholder:
Cardholder Signature:
Credit card transactions will be entered online by JAINA.
Please check if you do not want to receive occasional emails about the JAINA Convention 2005 & future conventions? STEP 6: SIGNATURE: Primary registrant must sign and date below::
On behalf of all registrants, I acknowledge and accept all the Terms and Conditions listed on the back of this registration form. SIGNATURE OF PRIMARY REGISTRANT;
Date:
Yes
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No