2011 Summer Course Registration
June 19 to 25

Polarities in Nature and the Nature of Polarity

Please mail or fax this registration form by June 1

Name _________________________________________________________

Address _______________________________________________________

City ______________________ State _________________ Zip __________

Home phone ______________________ Work phone ___________________

Fax ________________________ E-mail _____________________________

Course Fee:  $560 (less $30 if paid by May 1) 
Please pay in full by check (payable to The Nature Institute).

Tuition assistance is available. Please contact us (phone 518-672-0116).

__  I wish to stay in a private home and need housing for ____ nights.   
__  I would like more information about housing options.
__  I will arrange my own lodging.
__  I expect to have my own transportation.
__  I expect to need transportation.

Please let us know if you have any special needs.

Cancellation Policy:
If you cancel your registration more than two weeks prior to the beginning of the course you will be refunded the course fee minus $50.  If you cancel less than two weeks before the course begins you will receive a refund of the course fee minus $100.