Name: _________________________________________

Home address: ___________________________________

Country: ________________________________________

Age: ______          Sex:           M / F   (Circle one)

Phone & Fax # ___________________________________

E-mail # ________________________________________

· I would like to attend: the whole program    _____      part ________

· I will stay at the Vajra Vidya Institute        yes____     no_____

· I would like a reservation at the Golden Buddha Guesthouse   ____

· Date of Arrival in Sarnath: ______________________________

· Date of Departure: ____________________________________

Fees for Accommodation and Seminar Fee Accommodation at Vajra Vidya Institute - $10 daily including meals
Accommodation at Golden Buddha - $10 daily does not include meals Seminar Fee: -$80

For those staying at V.V.I. or Golden Buddha a $100 U.S. deposit is required in advance.
If registering by e-mail or fax, please send deposit by mail. Balance to be paid at beginning of seminar. All fees can be paid in advance.

By Cheque ___ By Money Order ____ By Wire transfer_____

Accommodation __________________

Seminar Fee __________________

TOTAL ENCLOSED: ___________________

Date received:_____________________