January 26-29, 2006 • Stardust Resort & Casino • Las Vegas, NV
REGISTRATION FORM
(Does not include accomodations)
Name ................................................................................................
Address ..............................................................................................
..........................................................................................................
City, State, Zip, Country ....................................................................
E-Mail Address ................................... Phone..................................
Are you a current JREF member?
(If you have only registered for the message boards, but have not joined the foundation, your answer is "No.") Circle one: Yes No
If you join or renew now, you may register at the member price. Membership level:
___Student(s) @ $25..........$ ..............
___Individual(s) @ $100.........$ ..............
___Friend(s) @ $250.........$ ..............
The Amaz!ng Meeting Registration fee: (No children under the age of 12 admitted )
Members @ $325 # attending.........$ ..............
Non-members @ $375 # attending.........$ ..............
Student Members @ $225 # attending.........$ ..............
Student Non-members @ $275 # attending.........$ ..............
(Students must include copy of valid student ID)
Single-Day Attendance: $125 for any one day
# attending ........ specify day ..........................................$ ..............
Thursday workshop 1-4 p.m. includes course materials $100
# attending.........$ ..............
Name of Additional Guest ........................................................................................
Address ....................................................................................................................
City, State, Zip ..........................................................................................................
E-mail Address..........................................................................................................
(Family-member registration will be at the same rate as primary attendee.)
Magic: Close-Up in Concert with Jamy Ian Swiss 4 showtimes, limited seating.
Thursday 9:30 # attending @ $25.....SOLD OUT..
Friday 11:00 # attending @ $25....SOLD OUT..Saturday 7:00 # attending @ $25.....SOLD OUT.
Saturday 9:00 # attending @ $25.....SOLD OUT.
Celebrity Dinner
Celebrity Dinner # attending @ $500.........$ ..............
Celebrity Dinner with Chosen Guest and Photograph # attending @ $1000.........$ .............Total amount enclosed: $ ..............
Payment: circle one: Check, Visa, MasterCard, Amex, Discover
Credit-card number ..................................................................................................
Expiration date and verification code (3-digit # on back of card)............................
Signature (credit-card orders only)............................................................................
Please make checks payable to James Randi Educational Foundation
Mail registration to:
James Randi Educational Foundation
201 SE 12 St.
Fort Lauderdale, FL 33316
Attn: TAM4Or call your registration in to (954) 467-1112 or fax it to (954) 467-1660.