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Workshop & Course selections on reverse side!

CONFERENCE REGISTRATION FORM A Complementary Healthcare Extravaganza

Daytona Beach Resort, Daytona Beach, Florida ~ May 19th – 21st, 2017 Full Conference Includes Saturday Banquet & Awards_Dinner! Full Conference before April 19th after April 19th Members $299 $359 Nonmembers $359 $399 Friday Only $159 Saturday Only (dinner not included) $159 Saturday Luncheon (additional fee) $25 Saturday Night Dinner $59 Sunday Only $119 Sunday Luncheon (additional fee) $25 Virtual Conference $259 $299 (Includes: unlimited access to all three lecture rooms – all handouts – and mp3 downloads of all the lectures ) Full Conference Includes Saturday Banquet & Awards Dinner!

Full Conference Fee Fri, Sat, Sun $_______

(Select from Member, Nonmember pricing)

Friday Only $_______ Saturday Only $_______ Sunday Only $_______ 2 Hr Workshop ($35) $_______ 3 Hr Workshop ($45) $_______ Pre Conference Course $_______ Post Conference Course $_______

Saturday Luncheon $_______ Vegetarian please check ����������������������������� Sunday Luncheon $_______ Vegetarian please check ���������������������������������� Saturday Dinner Only $_______ Vegetarian please check ���������������������������������� Virtual Conference $_______ Total Amount $_______

YES! I will be attending the Hypno Expo Conference

YES! I am a member of IACT IMDHA IAPH (circle one)

Name: _________________________________________

Address: _______________________________________

City: __________________________________________

State: _______________________ Zip: ______________

Phone: _________________________________________

Fax: ___________________________________________

Email: _________________________________________ Method of Payment (circle one) Cash Check M/O Credit Card

_______________________________________________ Credit Card Number (Visa/MC/Amex/Disc) Exp Date CVV#

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Signature

CONFERENCE REGISTRATION �ONLINE: www.iact.org / www.imdha.com �PHONE: 570-869-1021 �FAX: 570-869-1249 �MAIL 8852 SR 3001, Laceyville, PA 18623

�ROOM RESERVATION: Daytona Beach Resort 1-800-654-6216 or 386-672-3770 Use reservation code ���������� for special rate. �CANCELLATIONS: Full refund (less $25 administrative fee) must be made in writing prior to April 19th

You’re Invited! The International Association of Counselors and Therapists and the International Medical and Dental Hypnotherapy Association® take great pride in bringing you this incredible opportunity. Hypno Expo 2017 promises to be filled to the brim with new techniques and innovative ideas; Providing YOU with a ‘once-in-a-lifetime’ chance to learn from and network with the top educators in our profession. By committing to attend the conference, you have the unique opportunity to meet celebrated educators, create lasting memories and renew long-time friendships with professionals from around the globe!

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Stor

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The A

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Aller

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Magic

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Sp

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Re

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