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Name:
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Title:
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Primary Professional
and/or Volunteer Setting(s):
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Mailing Address:
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City/State/Zip:
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Phone:
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Email:
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| Please select 3 choices per workshop. |
Workshop #1
1st Choice
A
B
C
D
2nd Choice
A
B
C
D
3rd Choice
A
B
C
D
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Workshop #2
1st Choice
A
B
C
D
E
2nd Choice
A
B
C
D
E
3rd Choice
A
B
C
D
E
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Meals
Meals will be fish or vegetarian.
Do you require certified kosher meals?
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Yes
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Conference Fees
$395 Early Registration (Before February 17, 2009)
$495 Regular Registration
$300 Student Registration
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Limited Scholarships Available
I wish to make a tax-deductible donation
to subsidize conference scholarships.
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Donation amount $
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Continuing Education Units (Click for CME Statement)
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MDs, PsyDs
RNs, LCSWs, and MFTs
Birthdate (month/year)
Professional Specialty
Degree
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$100 (MDs, PsyDs Only)
$40 (RNs, LCSWs, and MFTs Only)
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Cancellation Policy
Full refund before March 10, 2009 (less $25 processing fee)
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Form of Payment:
Make check or money order payable to:
HUC/Kalsman Institute
3077 University Avenue
Los Angeles, CA 90007
If paying by visa or mastercard you will be contacted
for credit card information.
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Check / Money Order
Visa / Mastercard
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Hotel Reservations must be made directly with
the Asilomar Conference Center
(See Below)
Commuter Option is available. Please contact Yael Green at midrashandmedicine@huc.edu if interested.
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Total:
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ASILOMAR CONFERENCE CENTER, Monterey, CA
Asilomar Registration
(click here to download registration form)
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Fax to (831) 642-4262 or
Mail Asilomar Registration form with check payable to DNC P&R at Asilomar.
Asilomar Conference Grounds
P.O. Box 537
Pacific Grove, CA 93950
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Room Rates
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Fees include room and all meals for TWO NIGHTS*
There are a limited number of wheelchair accessible rooms.
There are some triple and quad rooms
available at lower per-person rates.
*$19 reservation fee required for room reservation
Contact Asilomar at (831) 372-8016
for more information.
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STANDARD ROOM
Single Occupancy $419.22
Double Occupancy $264.22 each
HISTORIC ROOM
Single Occupancy $335.62
Double Occupancy $233.42 each
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