Each participant must fill out a separate registration form.  Please type or print clearly.

            1.         To pay by money order, mail this page, along with a money order in US dollars—made out to International Religious Liberty Association or IRLA—to Carol Rasmussen, IRLA Office, 12501 Old Columbia Pike, Silver Spring MD 20904 USA.

            2.         To pay by credit card, fax this page to 301-680-6695 or e-mail the information to rasmussenc@irla.org.  Registration may not be done by telephone

Name (family name last):                                                                                                                      

Spouse name (if attending):                                                                                                                  

Address (including country):                                                                                                              

                                                                                                                                                                   

E-mail Address:                                                  

Fax number:                                                       Phone number:                                                           

Please indicate the items and amount for which payment is being made.  Discounted rates apply to payment which reaches the IRLA Office by October 31, 2006.

Registration fees for registration by October 31, 2006: 1) $375 for participants from outside Africa; 2) $100 for participants from Africa*

Registration fees for registration beginning November 1, 2006: 1) $425 for participants from outside Africa' 2) $130 for participants from Africa*

            Registration fee (see amounts listed above)                                      

            Banquet for spouse ($38)**                                                                 

            Friday Tour for participant ($90)***                                                   

            Friday Tour for spouse ($90)***                                                         

                                                Total Amount                            $                     

Name as it appears on Credit Card:                                                                           Credit Card Number: __________________________________

Type of Credit Card:  Master Card            Visa            American Express            Discover      

Expiration Date:                         Total amount to be charged in US dollars:                                           

Signature of person whose name appears on credit card:                                                                      

You will be notified by fax or e-mail when you have been successfully registered.
* The charge is reduced for participants from Africa because of subsidies provided by sponsors
** Tickets purchased will be available for pickup when you arrive at the Cape Town Convention Centre.
*** An optional tour is offered on Friday, March 2. It includes a trip up Table Mountain by cableway, a mini-tour of Cape Town, and a trip by hydrofoil to Robben Island where former President Nelson Mandela was imprisoned.