Name:
Title:
Primary Professional
and/or Volunteer Setting(s):
Mailing Address:
City/State/Zip:
Phone:
Email:

Please select 3 choices per workshop.
Workshop #1
1st Choice  D
2nd Choice  D
3rd Choice  D
Workshop #2
1st Choice  E
2nd Choice  E
3rd Choice  E

Meals
Meals will be fish or vegetarian.
Do you require certified kosher meals?

Yes

Conference Fees
      $395 Early Registration (Before February 17, 2009)
$495 Regular Registration
$300 Student Registration

Limited Scholarships Available
I wish to make a tax-deductible donation
to subsidize conference scholarships.

Donation amount $
Continuing Education Units (Click for CME Statement)
MDs, PsyDs
RNs, LCSWs, and MFTs
     Birthdate (month/year)
     Professional Specialty
     Degree
$100 (MDs, PsyDs Only)
$40 (RNs, LCSWs, and MFTs Only)


Cancellation Policy
Full refund before March 10, 2009 (less $25 processing fee)

Form of Payment:
Make check or money order payable to:
HUC/Kalsman Institute
3077 University Avenue
Los Angeles, CA 90007
If paying by visa or mastercard you will be contacted
for credit card information.

Check / Money Order
Visa / Mastercard

Hotel Reservations must be made directly with
the Asilomar Conference Center

(See Below)

Commuter Option is available. Please contact Yael Green at midrashandmedicine@huc.edu if interested.
Total:

ASILOMAR CONFERENCE CENTER, Monterey, CA
Asilomar Registration
(click here to download registration form)

Fax to (831) 642-4262 or
Mail Asilomar Registration form with check payable to DNC P&R at Asilomar.
     Asilomar Conference Grounds
     P.O. Box 537
     Pacific Grove, CA 93950

Room Rates
Fees include room and all meals for TWO NIGHTS* 
There are a limited number of wheelchair accessible rooms.
There are some triple and quad rooms
available at lower per-person rates.

*$19 reservation fee required for room reservation

Contact Asilomar at (831) 372-8016
for more information.

STANDARD ROOM
Single Occupancy $419.22
Double Occupancy $264.22 each

HISTORIC ROOM
Single Occupancy $335.62
Double Occupancy $233.42 each