Pacifica Graduate Institute | Public Programs & Conferences

Registration Form
The Legacy of Joseph Campbell

Complete this registration, then print it out and return it to Pacifica Graduate Institute with your payment.

First Name:

Last Name :

Address:

City:

State/Province:

Zip/Post Code:

Country:

Home Phone:

Work Phone:

Fax:

Email:

Conference:

General Admission Fee:
$475

Special Admission Fee:
$425

(check one of the catergories below)

Full Time Student
School

Pacifica Alumni

Senior (65 years & older)

Joseph Campbell & Marija Gimbuta Library Member

Pre-Conference Workshops:

Phil Cousineau:
$130

Stephen Aizenstate & Maren Hasen:
$130

Continuing Education Credit:

($15 each certificate)

Library Membership :

I would like to become a member of The Joseph Campbell and Marija Gimbutas Archives & Library ($50 annual membership):

Please indicate method of payment:

Check Enclosed:

Payable to Pacifica Graduate Institute

Please Charge:

Mastercard
Visa
Discover

Account Number:

Expiration Date:

Cardholder Name:

Signature:

_________________________________________

TOTAL ENCLOSED:

I am interested in finding a roommate:

I am Female Male

Submit this completed Registration by mail to:
Pacifica Graduate Institute
Public Programs
249 Lambert Road, Carpinteria, CA 93013

Or by fax to: 805-565-5796