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 April 23 - 27, 2010
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:
From USA and Canada Only 1-250-665-7883 :: International Fax USA 001 250 665 7883
Mail Checks to: InMed, 1231 Country Club Drive, Carson City Nevada 89703 USA