REGISTRATION

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First International
Quantum Science Symposium -2011-Boston/Cambridge
Courtyard Marriott, 777 Memorial Dr, Cambridge, Massachusetts, 02139 USA
                   September 26 - 27, 2011

   REGISTRATION  FORM

GeneExpression Systems, Inc. P.O. Box 540170, Waltham, MA 02454-0170 USA

Register for (Check one):Quantum Biol-Meeting___ Quantum Computing (QICC) Meeting____
Register the following Industry delegate(s) for this conference:  US $999 ____
Register the following Academia/Government delegate(s):       US $499____
Register the following PhD students: (fax a copy of your id)       US $199 ____
REGISTRATION COSTS INCLUDES: Break refreshments for two days, but NOT Room accommodation
Poster presentation (Abstract handling fee)                                         US  $75____
LATE FEE:                  
Registration Charges from Aug 05 - Aug 21:                     additional $ 50
Registration Charges from Aug 22 to Sept 08:                  additional $100
Registration Charges from Sept 09 to Sept 23:                 additional $150
On site Registration (from Sept 24-27):                           additional $ 200                                    

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