To register and reserve your spot, please fill out the form below. Tickets are $300.

ALL registration monies not from the United States must be in U.S. currency in
the form of a U.S. Money Order or a U.S. Cashier's Check, this includes Canada.
For your convenience we also are now accepting VISA and MasterCard. Be sure to
include all credit card information: the number, name as it appears on card and
expiration date.

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I would like to reserve: _______ Tickets

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Credit Card Information    _____ VISA      _____ MasterCard
 

Card Number: ___________________________________________________________


Name as it appears on card: ____________________________________________
 

Expiration date: ________/_________/__________


Name: __________________________________________________________________
 

Referred by: ___________________________________________________________


Email Address: _________________________________________________________
 
 
Address: _______________________________________________________________
 
 
City: _____________________________________________
 
 
State/Province:____________________
 
 
Zip/Postal Code: _________________________________ 
 
 
Country: __________________________________
 
 
Phone No. w/area code: (Day) _____________________________
 
 
(Eve)________________________________
 

Mail payment and this form to:

Mt. Shasta Magazine
P.O. Box 1289
Mt. Shasta, CA 96067
Phone: 888-926-9255 / 530-926-5500
FAX: 530-926-1193     Email: msmag@bestweb.net

Do you want to receive the Wesak Packet?     Yes _____     No _____
http://www.wesak.us      http://mountshastamagazine.com