MAIL-IN REGISTRATION FORM for the 22nd Annual Conference of the International Association for the Study of Dreams California Dreaming June 24-28, 2005 at the Doubletree Hotel in Berkeley, California CONFERENCE REGISTRAION on-line is requested whether you pay on-line or not, however, if not practical then you may register by printing and filling out the registration form below. Mail either completed form with your payment or payment information to: 2005 Conference Registration IASD Central Office 1672 University Avenue Berkeley, CA 94703 [Contact our Conference Office at conference@asdreams.org or Tel: +1-866-Dream12 (+1-866-373-2612) if you do not receive a confirmation within 20 days] HOTEL REGISTRATION: Also please phone in and make your DoubleTree hotel reservations directly with the hotel, but do it right away to ensure that you get the discounted conference rate from the limited block of rooms we have reserved. Marina/San Francisco/Golden Gate Bridge View rooms will be offered at the special ASD rates only on a 'first come first serve' basis so don't delay. Reserve directly with the DoubleTree by calling (510) 548-7920 . Ask for the special ASD Conference group rate: $119 single, $129 double plus state and local tax. Reservations must be guaranteed for late arrival. These rates are available on a limited basis from June 23rd through the 29th. Those who decide to stay through July 4th Holiday will also be offered the special Group rate of $119 which will include breakfast for two. Call the hotel for details. Extra roll-away beds are available at an additional charge by advance request. Participants are responsible for their room, tax, and incidental charges. Check with hotel for cancellation and check-in policies. Hotel guests are entitled to complimentary parking and use of the Hotel Fitness Center and the two indoor swimming pools, whirlpools, and sauna. MEMBERSHIP DISCOUNT: In order to take advantage of the discounted member rates below you may join or renew your membership go to the membership page at www.asdreams.org, where you may join on-line or find the printable membership forms. Membership Rate Schedule (for information purposes) Individual = $ 100 Couple (receive 1 copy of publications) = $150 Student or Limited Income* = $ 65 Patron = $ 150 or more CONFERENCE AND EVENT FEES ========================= Circle the category and rate that applies and place the total on the line below each fee schedule. FULL CONFERENCE: JUNE 24-28, 2005 Friday evening through Tuesday (includes all Receptions and Dream Ball) Before June 10 ASD Member = $ 395.00 Non member = $ 485.00 Member Student/Limited Income = $ 310.00 Non Member Student/Lim Income = $ 365.00 After June 10 ASD Member = $ 415.00 Non member = $ 505.00 Member Student/Limited Income = $ 330.00 Non Member Student/Lim Income = $ 385.00 Place fee HERE if you are attending the Full Conference $ ____________ OR WEEKEND MINI-CONFERENCE: JUNE 24-26, 2005 Friday evening through Sunday afternoon (includes Opening Reception and Art Reception) Before June 10 ASD Member = $ 250.00 Non member = $ 310.00 Member Student/Limited Income = $ 200.00 Non Member Student/Lim Income = $ 235.00 After June 10 ASD Member = $ 260.00 Non member = $ 320.00 Member Student/Limited Income = $ 210.00 Non Member Student/Lim Income = $ 245.00 Place fee HERE if you are attending only the Mini-Conference $ ________ OTHER - Those with alternate arrangements please place appropriate fee on the lines above and specify status or arrangement here: * NOTE: a) Limited Income applies under $22,000 USD annually. b) For student rates to apply, documentation verifying full-time student status must be attached to this form. CE (CONTINUING EDUCATION) Processing Fee if CE credits are desired = $ 40 Place CE fee Here to obtain a CE booklet and credits $ ___________ LUNCHEON BUFFET PACKAGE DoubleTree Luncheon Buffet package (includes tax + tip; discounted from $17.95 per meal) Saturday and Sunday Luncheon Package = ______ pers @ $ 28 per person Monday and Tuesday Luncheon Package = ______ pers @ $ 28 per person 4 day Conference Luncheon Package = ______ pers @ $ 52 per person Enter number of persons per pkg above and place total HERE $ _________ SUNSET BAY CRUISE, RECEPTION AND DESSERT BUFFET 2 hr Cruise, Dessert Buffet w Coffee/Teas plus Cash Bar (a $25 value) Sunday Evening Cruise @ $ 12 per person (registrants only) Place total for Cruise Ticket HERE $ _________ GRAND TOTAL - add fees above, place total here for payment $ ______________ REGISTRANT INFORMATION: ======================= Name Of Registrant:______________________________________________ Day Phone: ____________________ Evening Phone: __________________ Street Address: __________________________________________________ City: ___________________________________________________________ State/Region: ____________________________________________________ Postal/Zip Code: _______________ Country: __________________________ E-Mail (Required Unless None Available): _____________________________ Web Site (if applicable) ____________________________________________ May we share your address information on a list for conference attendees? ____ YES ______ NO May we share your name and address information on our general mailing list? ____ YES ______ NO Check Status: ____ 1st ASD conference; ___ Presenter; ___ ASD Board; ____ Officer; ___ Host Committee; ____ Volunteer Payment Information: ==================== CHECK OR MONEY ORDER Amount Enclosed $ ________________ CHARGE CARD Card Type: ______ Visa, ______ Master Card Cardholder Name ___________________________________________ Cardholder Phone Number ___________________________________ Cardholder e-mail _________________________________________ Credit Card Number ________________________________________ Expiration Date __________, CVC Numbers (3#s on back) ________ Signature __________________________________________ REFUND POLICY - refund requests for conference will be subject to a $100 processing fee. No refunds after 10 June. Please check with the hotel on policy when you register, to avoid hotel cancellation charges. Comments or Questions (note student, limited income and presenter status here):