REGISTRATION
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Therapeutics Discovery Symposia – 2013
on ‘RNAi, Epigenomics, Stem Cells & Optogentics’
Venue: Hilton Garden Inn, 420 Totten Pond Road, Waltham, Massachusetts, 02451 USA
May 1 - 2, 2013
REGISTRATION FORM
GeneExpression Systems, Inc. P.O. Box 540170, Waltham, MA 02454-0170 USA
Tel: 781-891-8181; Fax: 781-730-0700 OR Fax: 781-891-8234;
Email: Genexpsys@expressgenes.com; www.expressgenes.com
Check One: RNAi, miRNAs & SCB ______, Stem Cells & Signaling ______, Optogenetics _____,
Register the following Industry delegate(s) for this conference: US $1199 ___
Register the following Academia/Government delegate(s): US $ 699___
Register the following PhD students: (fax a copy of your id) US $ 399___
REGISTRATION COSTS INCLUDES: Break refreshments for two days, but NOT Room accommodation
Poster presentation (Abstract handling fee; Poster Size: W 3 Ft x L 4 ft) US $ 100
LATE FEE:
Registration Charges from March 16 to March 31: additional $ 50 __
Registration Charges from April 01 to April 15: additional $100 __
Registration Charges from April 16 to April 30: additional $150 __
On site Registration (May 1 - 2): additional $ 200 __
Cancellation policy: Substitutions are always welcome. Cancellations before 90days: 70% refund
Cancellations before 60days 50% refund Cancellations before 30 days NO REFUNDS
Name (print first, then last): _________________________________________________________
Title/Designation: ______________________________________________________________
Company/Institution: _______________________________________________________________
Address: _________________________________________________________________________
City/State/Zip Code/Country: ________________________________________________________
E-Mail: ____________________________________________________________________
Phone: __________________________________ Fax: ____________________________________
Payment Method:
Check enclosed:____ CHECKS CAN BE WRITTEN IN EITHER: US $ or UK ₤ or Euros € and
Bill my company ____ Mail to: PO Box: 540170, Waltham, MA 02454-0170, USA
Charge my credit card: (check one) TRANSACTIONS WILL BE PROCESSED IN US DOLLAR CURRENCY
AmEx____ Visa ____ MasterCard____ Discover____
Billing Address (If different than the above)
Card Number: ______________________________________Security Code # (front/back on card):_______
Expiration Date: ____________________________________Street:___________________________
Name (as shown on card): ____________________________City/Country:_____________________
Signature of the cardholder _______________________Zip Code:______________________
How did you hear about this meeting? Ad in Journal (circle): Science, Nature, Cell, New-Scientist, The Scientist, Genes & Dev, RNA, GES-Email Alert__, GES website__, Poster __, Post Card _, Brochure__, Other Web Ad_ , Referral __.
Substitutions/Cancellation Policy:
In case if your schedule prevents you to attend after registration we will accept a substitute colleague from your company at any time at no charge. However, we have to be notified in advance to prepare badges etc.
Cancellations before 90days: 70% refund
Cancellations before 60days 50% refund
Cancellations before 30 days NO REFUNDS
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