Name:
Address:
City:
State:
Zip code:
Country:
Phone (H):
Phone (W):
Cell phone:
Fax:
E-mail:

Are you currently attending Alexander Alliance as a full-time student?
yes no

How will you travel to the course?
plane car train bus


Specify your choice of time period:
Option I - Entire Six Day Event: $400
Option II - Four Evenings of Class & Practica: $50
Option III - Full Weekend Event: $150
choose Option I - Entire Six Day Event: $400 Option II -Four Evenings : $50 Option III - Full Weekend Event: $150

Total amount due (see chart above):
Subtract 10% discount if you register and pay
before April 2, 2004


Method of payment:
(check, money order)
choose check money order other

Date of payment (and registration):



Any brief comment:
If you are coming from outside the USA, let us know
if you wish assistance with transportation or lodging