PLEASE PRINT THIS REGISTRATION FORM AND FAX IT TO US (Home Page)
FIRST NAME :
_______________________________

 ARE YOU A PRACTITIONER?: ________________ 		LAST NAME :
 ____________________________________

TYPE (ND, MD, HMD...)  ___________________

MAILING ADDRESS:  _______________________________________________________________________
_______________________________________________________________________________
Phone: ____________________ Fax: _____________________ Email: ______________________
HOW DID YOU HEAR OF INMED'S SEMINARS?  ________________________________________________

Ozone Therapy Course, Grand Sierra Resort and Casino, Reno Nevada October 24, 25, 26, 2008
Please Book your Hotel Room by Calling the grand sierra Resort as soon as possible
at 775-789-2000. Book your room now to ensure there is a room available.

HOW WOULD YOU LIKE TO PAY FOR THE COURSE?   (PLEASE CHECK ONE)

  PERSONAL CHECK (payable to InMED, Inc.)

  VISA

  MASTER CARD

CARDHOLDER'S NAME (PLEASE PRINT) _________________________________________________________

CARD NO. ___________-__________-__________-__________

EXP. DATE ________________

CARDHOLDER'S SIGNATURE:  _______________________________________________________

  • $50 cancellation fee with 30-day notice.  1/2 registration fee refunded with less than 30-day notice

Please Return this Registration Form by Fax to InMed:
Toll Free (USA and Canada Only) 1-888-543-3439 :: International Fax USA 001 250 654 0093
Mail Checks to: InMed, 1231 Country Club Drive, Carson City Nevada 89703 USA