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REGISTRATION
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Physical Sciences Symposia USA – 2015
on
‘Crystal & Graphene Science, and Quantum Science’
Venue: Courtyard MARRIOTT Hotel
777 Memorial Drive, Cambridge/Boston, Massachusetts, 02139, USA
SEPTEMBER 21 - 22, 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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CHECK ONE: Crystal & Graphene ______, Quantum Science ______,
Register the following Industry delegate(s) for this conference: US $ 999 ____
Register the following Academia/Government delegate(s): US $ 599 ____
Register the following PhD students: (fax a copy of your id) US $ 299 ____
Poster presentation (Abstract handling fee; Poster Size: W 3 Ft x L 4 ft) US $ 75 ____
REGISTRATION COSTS INCLUDES: Break refreshments for two days, but NOT Room accommodation
LATE FEE:
Registration Charges from August 06 to August 20: additional $ 50 __
Registration Charges from August 21 to September 05: additional $100 __
Registration Charges from Sept. 06 to Sept. 20: additional $150 __
Onsite Registration: additional $ 200 __
Cancellation policy: Substitutions are always welcome. Cancellations before 90days: 70% refund
Cancellations before 60days 50% refund Cancellations before 30 days NO REFUNDS
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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