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REGISTRATION
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Physical Sciences Symposia 2013-Boston
Hilton Garden Inn, 420 Totten Pond Road, Waltham, Massachusetts, 02451 USA
September 4 - 5, 2013
GeneExpression Systems, Inc. P.O. Box 540170, Waltham, MA 02454-0170 USA
Check One: Crystal & Graphene ______, Quantum Science______, New Particle Physics _____,
Register the following Industry delegate(s) for this conference:US $999 ____
Register the following Academia/Government delegate(s): US $599____
Register the following PhD students: (fax a copy of your id) US $299____
REGISTRATION COSTS INCLUDES: Break refreshments for two days, but NOT Room accommodation
Poster presentation (Abstract handling fee; Size of Poster W 3ft x L 4ft) US $75____
LATE FEE:
Registration Charges from July 15 to July 31: additional $ 50 __
Registration Charges from August 1 to August 15: additional $100 __
Registration Charges from August 16 to Sept 3: additional $150__
On site Registration: additional $ 200 __
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 Chemistry, Nano Letter, New-Scientist, The Scientist, Physical Reviews, 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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