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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

GeneExpression Systems™ All Rights Reserved 2013