CPDD 77 ANNUAL SCIENTIFIC MEETING Registration Information

Transcription

CPDD 77 ANNUAL SCIENTIFIC MEETING Registration Information
CPDD 77th ANNUAL SCIENTIFIC MEETING
Arizona Biltmore Hotel, Phoenix, Arizona
CPDD MEETING: June 13 – June 18, 2015 // INRC MEETING: June 15 – June 19, 2015
Meeting Registration
Method of Payment
Total Amount Due for Meeting Registration: $
First Name
Please X One:
Last Name
REQUIRED: 3 or 4 digit Code: __ __ __ __
Company Affiliation REQUIRED
Card Number
Mailing Address
City
Check Payable to Frosch/CPDD 2015
Charge to the following card: __MC __VA __ AX __ DS
State
Phone REQUIRED
Zip
Exp Date
Credit Card Billing Address
Country
City
Fax
E-Mail REQUIRED:
State
Zip
Country
Name as it appears on card (please print)
Dietary Restrictions:
Signature of Cardholder (required if paying by Credit Card)
Registration Information
Please Note: Cardholder signature above authorizes Frosch Global Conferences and Events to bill the
above credit card for meeting registration fees in conjunction with the 2015 CPDD Meeting.
Cancellations subject to $75.00 per person administrative charge
No refunds after Friday, May 29, 2015.
Additional Email for Receipt:
Please mark an X on the applicable category
Early Bird (by April 20)
Standard Rate (after April 20)
CPDD REGISTRATION
__ Elected Member (w/paid dues)
$ 495
$ 595
__ Non-Member
$ 675
$ 800
__ Non-Member Postdoctoral Fellow (NEW!)
$ 550
$ 650
__ Non-Member Predoctoral Student w/I.D.
$ 450
$ 475
__ Member-In-Training (w/paid dues)
$ 400
$ 425
__ Developing Countries (Must be on approved list) $ 400
$ 425
__ Accompanying Social: ____________________ $ 250
$ 275
__ Waived (Please mark an X for: __Approved Speaker OR __Approved Awardee)
AND Are you a: __ Member __ Non-Member __Predoctoral __Accompanying Social
COMBINED CPDD/INRC REGISTRATION
__ CPDD Member/INRC/Postdocs
$ 800
$ 900
__ CPDD Non-Member/INRC
$ 950
$ 1125
__ CPDD/INRC Predoc/CPDD MIT
$ 650
$ 765
Voluntary Contributions (circle one): Cochin, Eddy, Fischman, Holtzman, Morrison
$ ___________________________________
Return Completed Form to:
Frosch/CPDD 2015
Attn: Dusty Landwehr
700 Airport Blvd, Suite 360, Burlingame, CA 94010
OR Fax to Frosch at: 650-288-3268
OR Email to [email protected]
(if you are faxing/emailing, do NOT mail original form)
Registration Questions: Please contact Frosch Global Conferences & Events at
844-849-8159 or email [email protected]
Airline Tickets: For assistance with air travel, please contact Teresa Williams at
615-463-4110 or email [email protected]
HOTEL BOOKING:
Please visit www.arizonabiltmore.com/booking and enter the
group code: CPDD to make your hotel reservations. Rates start at $189 per night plus a
$15 resort fee & taxes. A 2 night deposit is required. A porterage charge of $12/room
and daily $3 housekeeping fee will be applied as well.
Book early to ensure availability as hotel rooms are not guaranteed after April 13, 2015.
A limited amount of lower priced rooms for Students and Government Employees will
be available at the Embassy Suites Phoenix. Please visit www.cpdd.vcu.edu for more
information and rate details.
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