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REGISTRATION
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First International
Metabolomics 2012 Symposium
The John B. Martin Conference Center at the Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
July 09-10, 2012
REGISTRATION FORM
GeneExpression Systems, Inc. P.O. Box 540170, Waltham, MA 02454-0170 USA
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; Size of Poster W 3ft x L 4ft) US $100____
LATE FEE:
Registration Charges from Feb 15 - Feb 29: additional $ 50__
Registration Charges from Mar 01 to Mar 15: additional $100__
Registration Charges from Mar 16 to Mar 31: additional $150__
On site Registration (from April 01-02): 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, Physics Rev, New-Scientist,
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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