International Herb Symposium Registration Form
Registration Form
Contact Information
Name (first): _________________________________
Last: _______________________________________
Address:____________________________________ ___________________________________________
City: ____________________________
State: _________ Zip: _______
Phone: _________________________________
Fax: _________________________________
Email: _________________________________
Symposium Tuition
$255 Early Bird Registration until March 30th (must include full payment for lodging, meals and intensives to qualify for EBR)
$ ______
$295 after March 30th
$ _________
One day IHS Passes
$125 One Day Registration with Meals: ___Fri ___Sat. ___Sun $_____
$100 One Day Registration w/out Meals: __Fri. __ Sat. __ Sun. $_____
Teens & Children:
$195 Teen(s) age(s):
Name (s):____________
Age(s) ________
$ ______
$150 Children 2-12:
Name(s) _____________
Age(s) ________
$ ______
Lodging and Meal Package
2 nights Basic Lodging & Meal Package
$155 pp for Double/Triple Occupancy $ _____
$175 Single occupancy. $ _____
2 nights Deluxe Lodging & Meal Package
$195 pp for double occupancy $ _____
$235 for single occupancy. $ _____
Extra night(s) lodging for Thursday or Sunday night
Basic Lodging extra night = $35 pp per night
$ _____
Deluxe Lodging extra night = $65 pp per night
$ ______Meal Option only (Fri. Dinner through Sun. lunch): $75 $_____
Please indicate which ‘extra’ night(s) are needed
___ Thurs
____ Sun.
$ ______
Symposium Proceedings Book
$12 each when ordering at time of
Registration. $12 X ____ of copies: $ _____
Nurses Path & Vet Tracks
Nurses Path
$120 processing fee for CNE Credits $ _____
VBMA VET Track: $35 $ _____
Intensive Classes
Please check each Intensive you wish to attend
PreConference Intensives
___ (1) Spiritual Bathing & Healing Ceremonies
w/Rocio Alarcon
___ (2) Cupping for Herbalists w/ Julia Graves
___ (3) Developing the Plant/Person Relationship w/Isla Burgess
___ (4) Wild Plant and Botan-Eyezing Walk w/Cascade Anderson Geller.
___ *5) VET TRACK: Vaccinosis: The Disease & Treatment w/Cindy Lankenau
___ (1) Talking Leaves; an Indigenous Language of Plants w/David Winston
___ (2) The Practices of Southern & Appalachian Medicine w/ Phyllis Light.
___ (3) Hawaiian Spirituality as Way of Life with Raylene Ha`alelea Kawaiae`a
___ (4) A Grower's Invitation for the Cultivation, Harvesting and Drying of Medicinal Herbs w/Reisen’s & Carpenter’s
___ (5) VET TRACK- TCVM Treatment Strategies for Tongue Quality Abnormalities in Animals w/Dr. Bruce Ferguson
___ (6) Healing Traditions & Plants from the Medicine Basket of Zapotec Grandmother w/ Grandmother Enriqueta Contreras
___ (7) Pulse & Tongue Diagnosis w/ Michael Tierra
___ (8) The Secrets of Soapmaking w/ Donna Winston
___ (9) Herbal Preparations 101 w/ Nancy Phillips
___ (10) Natural Cosmetics and Herbal Skin Care w/ Kate Rakosky
___ (11) Cancer Care and Support the Herbal Way w/ Kate Gilday
___ Total Intensives
Total Number of Intensives X $35 $____
Total Amount Due $______
Payment Information
We accept payment by PayPal, Credit Cards (Visa & Master Card) and Check.
Credit Card Payment
P please call Sage MT at 802.479-9825 or fill out form below and mail to IHS, P.O. Box 420, E. Barre, VT 05649 :
___ Master Card
___Visa
Card number: _________________________________
Expiration Date: _________
Name on Card if different than above:
_________________________________
Billing address if different than above:
____________________________
Signature on card:
_______________________________________
Payment by Checks, make payable to IHS and mail to P.O. Box 420, E. Barre, VT 05649
REGISTRATION CONFIRMATION
A Registration Confirmation Package with Directions, Schedule, and Updates will be emailed upon receipt of your Registration.
If you prefer to have your Confirmation Package mailed to you, please check here:
____ Yes, please mail my Confirmation Package to the above address
Additional Lodging Information Needed
Please fill this form out when registering as it will assist us in assigning the room of your choice:
Male ____ Female____ (so we can assign you to the right dorm floor)
Couple ____ (we reserve some of the dorm floors for couples)
If requesting a double/triple room, do you have a request for roommate(s)?
Room mate request(s)
(1) _________________________________
(2) _________________________________Please include the name of your roommate(s) when registering as it’s very difficult to change rooms later.
It makes our job so much easier if you can let us know at the time of registration your roommate request.Thank you!
If you need to be on a first floor due to health reasons, be sure to let us know at the time you register so we can assign a first floor room for you.
First floor necessary due to health reasons: _____