Registration Form
Click here
for the Registration, hotels, directions
Or Please print this page,
fill it out, and mail it with a check
or
Register on line through Pay Pal
.
Advance Registration
is required
so that we can adequately
plan for food and facilities.
The following persons are specifically invited:
-
The spiritual head of the institution (or delegate).
-
Current and former presidents, Board members, founders
-
Education Director/Interfaith/PR /Committee members
-
Female member/representative/coordinator from the organization
-
Youth coordinators – and young generation (16 to 30 year old) members
Last Name: ________________________________________________________________________
First Name: _______________________________________________________
Street Address: ___________________________________________________
C City _________________________State___________ Zip code ____________
Phone no. _______________________ Cell phone:_____________________
Email: _______________________________________________
Signature: _________________________________ Date: ________________
Institution you are affiliated with: __________________________________________
Y Title/function in the Institution:_____________________________________________
Registration before November 20: $100. Students $25
Nov 21 to Dec 10: $125. Students $35
Dec 11 to Dec 15/on-site: $150. Students $50
Kindly enclose a check (tax-deductible) payable to Hindu Collective Initiative
and mail this form with the check to: Dr. Ved P. Chaudhary
22 Jackie Drive, Morganville, NJ, 07751
Ved@hcina.org 732 972 1489
Credit Card # _____________________ Expiration date __________________
C Card type (circle): VISA MC 3 digit code (on the back of card) _______
Signature _______________________________ Date ___________________