REGISTRATION FORM
					
NAME: __________________________________________________

ADDRESS: _______________________________________________

CITY/STATE/ZIP: ________________________________________

TELEPHONE: _____________________________________________

Yes, I want to participate in the seminar.

___One Week     ___$1,400.00 per person in 2-person room

                ___$1,800.00 per person in 1-person room

___Two weeks    ___$2,500.00 per person in 2-person room

                ___$3,200.00 per person in 1-person room

___Three weeks  ___$3,400.00 per person in 2-person room

                ___$4,200.00 per person in 1-person room

___Four weeks   ___$4,000.00 per person in 2-person room

                ___$4,800.00 per person in 1-person room


Please indicate whether you are selecting a 1 or 2 person 
room. Room availability is limited, so early registration 
is recommended.
  Please list the name of your preferred roommate. We will 
do our best to accommodate your selection according to your 
dates of participation and registration.

Name of preferred roommate:

________________________________________________________

ARRIVAL DATE, time, airline, flight number:

________________________________________________________

DEPARTURE DATE, time, airline, flight number:

________________________________________________________

Please note: Each week package begins on Sunday with a check 
out on the following Sunday morning. Additional accommodations 
can be arranged for continued study or vacation after the 
seminar program ends. Costs are available upon request.

ALL PAYMENTS MUST BE MADE IN U.S. CURRENCY
via Cash, Bankcheck, Traveler's checks or Money order. Visa 
and Master Card are available for use only for seminar 
registration fee and bookstore sales while on the premises 
of the Center.

MAIL REGISTRATION FORM AND PAYMENT TO:

	      INNER PERCEPTIONS, INC.
	          P.O. BOX 2652
	   KAILUA-KONA, HI 96745, U.S.A.