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REGISTRATION
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Disease Therapeutics Symposium -2015
Epigenomics/Stem Cells & Metabolomics/Microbiome – 2015 Meetings
Courtyard Marriott Hotel, 777 Memorial Drive, Cambridge, Massachusetts, 02139 USA
August 24 - 25, 2015
REGISTRATION FORM
GeneExpression Systems, Inc. P.O. Box 540170, Waltham, MA 02454-0170 USA
Tel: 781-891-8181; Fax: 781-730-0700 OR Fax: 781-891-8234;
Email: Genexpsys@expressgenes.com; www.expressgenes.com
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Register for (Check one):Epi/Stem Cells-Meeting___ Meta/Microbiome Meeting____
Register the following Industry delegate(s) for this conference: US $1,199 ____
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; Poster Size: W 3 Ft x L 4 ft) US $75____
LATE FEE:
Registration Charges from July 10 to July 25: additional $50____
Registration Charges from July 26 to August 09: additional $100____
Registration Charges from August 10 to Augsut 23: additional $150____
On site Registration (from August 24-25): additional $ 200___
OPTIONAL: A hard cover text (2012) from Cambridge University Press on “Epigenomics: From Chromatin Biology to Therapeutics” Edited by K. Appasani is available for attendees at an extra cost of $180.00 Check if you need a copy____
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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