BSC Registration Form - BSC 2015

BSC Registration Form
1st Annual Meeting of the Biophysical Society of Canada (BSC)
Conference, hosted by the University of Waterloo, June 17-19, 2015.
Important Registration Information!
1. Each registrant must complete the form below. It contains
non-sensitive information that will be used to prepare an invoice for
each registrant. BSC members who wish to qualify for a reduced/free
registration must send confirmation/receipt of your BSC membership payment with this form and
send via email to Krystina Bednarowski at [email protected].
2. An invoice with payment instructions will be emailed to you in approximately 2 weeks of
submitting the form.
3. Your registration will be considered complete when payment of the invoice (via cheque or credit
card) is received in full. Payments made by credit card will be accepted through the University of
Waterloo secure invoice processing website.
If you have questions regarding registration, invoicing, or payment, please email or phone Krystina
Bednarowski at 519-888-4567 (ext 32732).
The deadline for early registration is May 31, 2015.
REGISTRATION AFTER MAY 31:
BSC Members $150
Non-Members $250
Student Members $50
Student Non-Members $150
Government/Industry Participants $350
Exhibitors & Sponsors $1,000
CANCELLATION POLICY:
100% refund up until April 30, 2015
50% refund from May 1 – May 31, 2015
No refunds after May 31, 2015
1. Registration Type
Please choose your type of registration. All dollars are in Canadian.
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BSC Members - $100
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Non-Members - $200
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Student Members - Free
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Student Non-Members - $100
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Government/Industry Participants - $300
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Exhibitors & Sponsors - $1,000 (includes 1 registration fee, 1 booth (table + poster board), and
company name on BSC 2015 website)
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BSC Registration Form
2. Personal Information
Prefix:
First Name:
Last Name:
Email Address:
Personal Address:
Street Address:
City:
Province/State:
Postal or ZIP
Code:
Country:
Telephone
Number:
Mobile Number:
Institution,
Company, and
Department:
3. Billing Address
Please fill this out only if the billing address is not the same as above.
Street Address:
City:
Province/State:
Postal/ZIP Code:
Country:
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BSC Registration Form
4. Do you require any special dietary considerations?
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Vegetarian
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Gluten-Free
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Other:
5. If you have a disability or condition that requires accommodation to support
your participation, please provide details below:
Please email the completed form to Krystina Bednarowski at
[email protected].
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