American Society for Virology 2013 Annual Meeting June 21-25, 2014 Colorado State University, Fort Collins Colorado REGISTRATION FORM This form may be duplicated for additional registrations. Please print in ink or type. Return to CSU Office of Conference Services by June 13, 2014. You can also register online at www.asv2014.com. PARTICIPANT INFORMATION Name: Gender:  Female  Male Affiliation: Address: City: State/Province: Country: Postal/Zip Code: Telephone: Email: Please list ADA Accommodations / Dietary Restrictions: Will you be presenting a talk/poster at the meeting?  No  Yes REGISTRATION FEES Graduate Student Fee (until April 21, 2014) Graduate Student Late Fee (beginning April 22, 2014) Undergraduate Student Fee (until April 21, 2014) Undergraduate Student Late Fee (beginning April 22, 2014) Member Fee (until April 21, 2014) Member Late Fee (beginning April 22, 2014) Nonmember Fee (until April 21, 2014) Nonmember Late Fee (beginning April 22, 2014) [_] $400 [_] $475 [_] $300 [_] $375 [_] $500 [_] $575 [_]$600 [_] $675 Number of Guest(s) (includes welcome reception and three socials) [_] $75 x ________ Name of your guest(s): _____________________________________________________________________ An additional charge of $50 will be added to each walk-in registration received after June 13, 2014. Total for Registration Conference Fees TOTAL $ _____ ADDITIONAL EVENTS ASV dinner (Tuesday, June 24, 2014) [_] $55 Veterinary Virology Club satellite symposium (Sunday, June 22, 2014) Plant Virology Club satellite luncheon (Saturday, June 21, 2014) Medical Virology Club satellite luncheon (Saturday, June 21, 2014) [_] $35 [_] $65 [_] $65 ASV T-shirt Indicate size: [_] $15 [_] XSmall [_] Small [_] Medium [_] Large [_] XL [_] XXL [_] XXXL Total for Additional Events TOTAL $ Total for Registration and Additional Events TOTAL $ LUNCH DISCUSSION TABLES As in previous ASV meetings, the Education Committee will sponsor lunchtime topics tables for students and postdocs. No cost is involved, but seating is limited. If you are interested, please enter the numbers 1-3 to rank a TOTAL of up to three (3) discussions that you would like to attend (1 is top choice). Attendees will be chosen by a lottery system and the selected attendees will be notified prior to the start of the conference to confirm your acceptance. Sunday June 22, 2014 [_] David Baltimore [_] Alexander Ploss [_] Rozanne Sandri-Goldin [_] Ekaterina Heldwein [_] Richard Lloyd [_] Junior Investigator TBA [_] Junior Investigator TBA [_] Finding the right postdoc for your career goals Monday June 23, 2014 [_] Clodagh O'Shea [_] Michael Imperiale [_] Maribeth Eiden [_] Thomas Shenk [_] PUI/Small College Teaching Careers [_] I don't want to be a PI, now what? [_] Finding the right postdoc for your career goals [_] Balancing work and family Tuesday June 24, 2014 [_] Jeremy Luban [_] Michael Gale [_] Savithramma Dinesh-Kumar [_] Carla Saleh [_] Networking, politicking, dealing with difficult colleagues [_] Balancing work and family [_] I don't want to be a PI, now what? [_] Teaching virology PAYMENT METHOD Please see registration information for details. Checks/wires must be in U.S. funds payable to: Colorado State University. *There will be a $17.00 fee charged on checks returned by the bank due to insufficient funds.* Payment Type Check Cash Credit Card Card Number Exp. Date / To adhere to Colorado State University’s PCI compliance rules, please DO NOT WRITE THE 3-DIGIT CSC CODE on this form. Deadline: All registrations must be received by 5:00 p.m. MDT on June 13, 2014. After this date, please call the CSU Office of Conference Services at 970-491-6222 or via email at [email protected] for information about on-site check-in; if space permits, you can register for an additional $50. Confirmation: CSU Office of Conference Services will confirm your registration via the email address listed above. You will be alerted promptly of any cancellations or changes. If some unforeseen event forces CSU Office of Conference Services to cancel or postpone the program, you will receive a full refund of your registration fee; however, the University cannot be held responsible for any related costs, including cancellation fees assessed by airlines or travel agencies. Refunds: If your request to withdraw is received prior to May 20, 2014, we can issue a partial refund. Send your written request via email at [email protected] or by fax to 970-491-3568. A $50 administrative fee will be charged for each withdrawal. Anyone who is registered but cannot attend may send a substitute. Access: CSU Office of Conference Services encourages persons with disabilities to participate in its programs and activities. If you anticipate needing special accommodations or have questions about the physical access provided, please contact CSU Office of Conference Services at 970-491-6222 at least two weeks prior to the conference. Mail to: Office of Conference Services 645 S. Shields Street 8037 Campus Delivery Fort Collins, CO 80523 Phone: (970) 491-6222/Fax: (970) 491-3568 Email: [email protected] www.conferences.colostate.edu