General Information

Travel Information

 


IPLANT CONFERENCE REGISTRATION
         Participant Information
Please do not fill out this form using all Caps (Use Title Case)

Title
First Name
* required
Middle Initial
Last Name
 *
Sex
 *
Affiliation/Organization
*
Affiliation type
 *
Department
 *
Street
 *
City
 *
State
Zip Code
-  
Country
 (Other than USA)
Foreign Postal Code
Foreign Phone
(include Country code)
Phone
 - - Ext.
Fax
Email
 *
Country of Citizenship
 *
Permanent US Resident?
Position
 * Media Guidelines

Lab Head [Last Name only]

 *
(15 characters max)
Meeting Title




Program Position
Organizer Invited Speaker Chair
Require Housing
Kosher Diet
Vegetarian Diet
Other Special Condition
Payment Information 

Find the meeting cost from the list below. 

Full Package $570
No Housing Package $370
Extra Day Package $770
  *
  Further additional nights - $165/day
Enter total into box below:

TOTAL DUE
   US$ * [do not use decimals or symbols such as $]
Payment Method
 *
Cardholder Name
Credit Card #
(No spaces please between #'s)
Expiration Date (mmyy) (example 0404)
Payment Authorized
US$
Please authorize payment of full amount with this registration.
Please be advised that we no longer accept Wire Transfers for payments
*Check #
*Clearly state the Attendee and Meeting names with check
 

Payment will be processed only once your registration has been accepted by the organizers.

Online Registrations will not be processed until a method of payment is indicated.

Checks payable to: Cold Spring Harbor Laboratory
     
 

Having trouble with this form? Please use Internet Explorer, Firefox, or Netscape browsers.

 
 

 

Cold Spring Harbor Laboratory
Meetings & Courses Program
PO Box 100, 1 Bungtown Road
Cold Spring Harbor, NY 11724-2213
Phone (516) 367-8346
Fax: (516) 367-8845

meetings@cshl.edu