To send to:              Jean-Marc Mantel, M.D.
 
                                jmm@essence-euro.org

Family name:                                                                                 First name:
Address:
City / Zip Code:                                                                             Country:
Phone home:                                                                                   Phone work:
Fax:                                                                                                Email:
Web page:
Occupation:

I am interested to lecture/present at the conference: y/n

If yes, title of the lecture/presentation:

A few lines describing the content:
 

I am interested to present a 2 hour experiential session at the conference: y/n

If yes, title of the session:

A few lines describing the content of the session:
 

We also need a few lines of biography about yourselves:
 

Please send by email a recent photo as an attachment. If you have no digital photo available, you could send a paper one to:

Shirley Kaiser, M.A.
SKDesigns
5150 Fair Oaks Blvd. #101-130, Carmichael, CA  95608, USA

(please write down on the back: UK presenter - Your name and include a self-addressed, stamped envelope if you wish to have your photo(s) returned.)

Thank you.