June 27-30, 2012, The Lodge at Vail, Vail, Colorado

APPLICATION: VVI'S "DYSFUNCTIONAL POLITICAL SYSTEM" SEMINAR

Just print this application page, fill it out, and mail to:
Vail Valley Institute, P.O. Drawer 1305, Vail, CO 81658

Tuition

[   ] $1,900 per person for full participants

[   ] $3,300 for full participant couples

[   ] $1,400 per person for auditors

[   ] $500 per person for mini-course participants

[   ] $200 per person for keynote dinner attendees

Deposit

[   ] Enclosed is my (our) deposit of $750 per person.

[   ] Enclosed is my (our) for ______ Anne-Marie McDermott concert tickets.

[   ] Check enclosed, payable to Vail Valley Insititute.

[   ] Please bill my ____Mastercard ____Visa ____AmEx

Reduced-Rate Rooms at The Lodge at Vail from $179

Please book me/us a room for the following evenings

[   ] Weds., June 27    [   ] Thurs., June 28   

[   ] Fri., June 29    [   ] Sat., June 30   

[   ] Reserve with ____Mastercard ____Visa ____AmEx

[   ] BasicRoom — $184/night    [   ] Deluxe Room — $219/night

Choose room preference(s): [   ] King bed, [   ] 2 Queen Beds

BRAVO! CONCERT: DALLAS SYMPHONY ORCHESTRA

Seminar attendees will be able to enjoy concerts on Wednesday, Friday and Saturday. Tickets are not included.

Credit Card

Name on Card

Number

Exp Date

CVV CODE (VISA & MC: a 3-digit code [last 3 digits] / AmEx: a 4-digit code on front of card)

I (We) understand that final payment in full is due no later than June 18, 2012.

Name(s)

Profession/ Volunteer Activities

Phones (day & eve)

E-mail

Indicate preferred mailing address

[   ] Business Address*

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[   ] Home Address*

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*Please check preferred mailing address.