The SMP Spring '00 Conference/Tour Registration

Name(s):___________________________________

                    
       ___________________________________


Children/ages (under 19):__________________________


                 _________________________

Address:___________________________________

State:_________ Zip:_____________

Telephone:
(home):________________________

(office):________________________

fax:___________________________

email: _________________________

Cruise & Air $_____________Includes transfers to and from airport.

Cruise Only $_____________

Mini Suite w/verandah $___________Outside Stateroom w/o

verandah $____________Inside Stateroom $______________

Amex / Visa / MC (circle one)

Card#:______________________________________Exp.__________


Please Print, fill out and return this form with your SMP deposit to:
(A $300 per person reservation fee)
Dr. T. Laquercia
15 West 12th Street
New York, NY 10011
Phone: (212) 242-1107
Email: tlaquercia@aol.com