REGISTRATION

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Stem Cells & Synthetic Biology - 2012 Summit
Venue: Hilton Garden Inn, 420 Totten Pond Road, Waltham, Massachusetts, 02451 USA
May 1 - 2, 2012
 REGISTRATION FORM

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

Register the following Industry delegate(s) for this conference:US $1199 ____
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; Size of Poster W 3ft x L 4ft)    US  $100____

LATE FEE:                  
Registration Charges from March 16 to March 31:                additional $ 50 __
Registration Charges from April 1 to April 15:                      additional $100 __
Registration Charges from April 16 to April 30:                    additional $150__
On site Registration from May 1-2:                                           additional $ 200 __ 

OPTIONAL PURCHASE OF BOOKS:
Stem Cells Book (2011): ‘Stem Cells & Regenerative Medicine’ Springer Press, Ed. K. Appasani Forwarded by Sir John Gurdon  Additional Cost    US $180.00 Check if you need a copy___
Epigenomics Book (2012): ‘Chromatin Biology to Therapeutics’ Cambridge University Press, Ed. K. Appasani Forwarded by Sir Azim Surani Additional Cost    US $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, Cell, New-Scientist, The Scientist, Genes & Dev, RNA, 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