________________
JAIN DIGEST
REGISTRATION FORM:
Register online at http://convention.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
Home Phone
Country/Region
18th Biennial JAINA Convention
2000 Convention Center Concourse, College Park, GA 30337 July 2nd-5th, 2015
Last Name
Emergency Contact:
STEP 2: CONVENTION REGISTRATION Please list all attendees including infants.
Individual Registration Fee
First Name
No. of attendees requesting VEGAN food: STEP 3: INDIVIDUAL REGISTRATION FEES:
ADULTS (AGE 18 & UP)
CHILD/YOUTH (AGE 6 - 17)
JNF/Jain Milan (Age 21-40)
Cell
Please make your check (US$) payable to: JAINA CONVENTION
Mail registration form and check to:
JAINA CONVENTION
P.O. Box 072015
Atlanta, GA 30301 U.S.A.
EMAIL: registration2015@jaina.org
PHONE: 1-770-870-0500
56 I MAY-JUN 2015
City
Sex M/F
SIGNATURE OF PRIMARY REGISTRANT:
Email
Age
FEB 16 to MAY 15
$199
$169
$125
from chart in
Step 3
Phone:
JNF/Jain Milan
Age 21-40 from chart in Step 3
Total Registration Fees (US$)
MAY 16
to JUNE 25
$209 $229
$189 $209
$135
$145
On site
Day Care needed* Yes No
Evening Social Activities Age 14-40 from chart in Step 3
Notes: 1. Children up to age 5 are FREE. * Daycare will be provided for a fee. 2. After June 25, 2015, only On-site Registration will be available at above mentioned price/per attendee.
TOTAL REGISTRATION FEES FROM STEP 2
I would like to pay additional dollars to cover actual cost of $300 per attendee. GRAND TOTAL (US$)
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.
PAYMENT MUST BE MADE IN U.S. $ ONLY
TOTAL FEES
(US$/person)
Charge my CREDIT CARD below. I accept all the Terms & Conditions on this form. GRAND TOTAL AMOUNT ENCLOSED FROM STEP 3: $ O Discover பLLட *CVV Code:
Charge my: O Master Card |
O Visa |
U
Card #: Name of Cardholder: Cardholder Signature:
Exp. Date:
*CVV Code is the last three numbers on back of credit card. Credit card transactions will be entered on-line by JAINA.
Date:
