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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

_________________________________________________________________________________________________________
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

GeneExpression Systems™ All Rights Reserved 2015