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REGISTRATION

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Inaugural
Crystal & Graphene Science Symposium-2012-Boston
Hilton Garden Inn, 420 Totten Pond Road, Waltham, Massachusetts, 02451 USA
                   September 5 - 6, 2012

 GeneExpression Systems, Inc. P.O. Box 540170, Waltham, MA 02454-0170 USA


Tel: 781-891-8181; Fax: 781-730-0700 or 781-891-8234
Email: Genexpsys@expressgenes.com; www.expressgenes.com

Register the following Industry delegate(s) for this conference:US $999 ____
Register the following Academia/Government delegate(s):       US $499____
Register the following PhD students: (fax a copy of your id)     US $249
____
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 4:                    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

GeneExpression Systems™ All Rights Reserved 2012