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Peace through Dialogue
14th Biennial JAINA Convention o Taina
New Jersey Convention & Expo Center J2007
Edison, New Jersey USA
July 5-8, 2007 REGISTRATION FORM:
Register online at www.jaina.org. 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 Postal Zip Code
City
Home Phone
Fax
Email
Country/Region
Emergency Contact: STEP 2: CONVENTION REGISTRATION
Phone: Please list all attendees including infants.
Individual Jain Network
Registration Fee Forum (NF) Sex
from chart in Age 21-40 from M/F Age Step 3 chart in Step 3
Evening Social
Activities Age 14 - 35 from chart in Step 3
TOTAL
FEES (US$ / person)
Last Name
First Name
Total Registration Fees (US$) Day Care needed Yes No
No.of attendees requesting VEGAN food: STEP 3: INDIVIDUAL REGISTRATION FEES:
FEB 1 to APR 16 to APR 15 JUN 15
FROM JUN 16
TOTAL REGISTRATION FEES FROM
STEP 2 Donation towards inter-faith or needy
attendee ($ 100 suggested) GRAND TOTAL
(US$)
ADULTS (AGE 18 & UP)
$149
$169
$189
$79
$99
CHILD/YOUTH (AGE 6 UP TO AGE 17)
JNF (AGE 21-40) Social Activities (Age 14-35)
$80
$89 $90 $70
$100
$60
$80
PAYMENT MUST BE MADE IN U.S. $ ONLY
Note: Children up to age 5 are FREE.
Charge my CREDIT CARD below. I accept all the Terms & Conditions on this form. Please make your check (USS) payable to:
GRAND TOTAL AMOUNT ENCLOSED FROM STEP 3: $ JAINA CONVENTION
Charge my: O Master Card Visa
O Discover Mail registration form and check to:
Card #: LUUUUUUUUUUUUUUU JAINA CONVENTION
Name of Cardholder:
"CVV Code:L_LU P.O. Box 700 Getzville, NY 14068 U.S.A
Cardholder Signature:_
__Exp. Date: EMAIL: registration 2007@jaina.org
CVV Code is the last three numbers on back of credit card. PHONE: 1-716-636-5342
Credit card transactions will be entered on-line by JAINA. STEP 4: SIGNATURE: Primary registrant must sign and date below. I have read and accept the Terms and Conditions on the reverse side of this registration form.
SIGNATURE OF PRIMARY REGISTRANT:
Date:
antematonal
For Privata & Panel Use Only
