CPDD 77 ANNUAL SCIENTIFIC MEETING Registration Information
CPDD 77th ANNUAL SCIENTIFIC MEETING Arizona Biltmore Hotel, Phoenix, Arizona CPDD MEETING: June 13 – June 18, 2015 // INRC MEETING: June 15 – June 19, 2015 Meeting Registration Method of Payment Total Amount Due for Meeting Registration: $ First Name Please X One: Last Name REQUIRED: 3 or 4 digit Code: __ __ __ __ Company Affiliation REQUIRED Card Number Mailing Address City Check Payable to Frosch/CPDD 2015 Charge to the following card: __MC __VA __ AX __ DS State Phone REQUIRED Zip Exp Date Credit Card Billing Address Country City Fax E-Mail REQUIRED: State Zip Country Name as it appears on card (please print) Dietary Restrictions: Signature of Cardholder (required if paying by Credit Card) Registration Information Please Note: Cardholder signature above authorizes Frosch Global Conferences and Events to bill the above credit card for meeting registration fees in conjunction with the 2015 CPDD Meeting. Cancellations subject to $75.00 per person administrative charge No refunds after Friday, May 29, 2015. Additional Email for Receipt: Please mark an X on the applicable category Early Bird (by April 20) Standard Rate (after April 20) CPDD REGISTRATION __ Elected Member (w/paid dues) $ 495 $ 595 __ Non-Member $ 675 $ 800 __ Non-Member Postdoctoral Fellow (NEW!) $ 550 $ 650 __ Non-Member Predoctoral Student w/I.D. $ 450 $ 475 __ Member-In-Training (w/paid dues) $ 400 $ 425 __ Developing Countries (Must be on approved list) $ 400 $ 425 __ Accompanying Social: ____________________ $ 250 $ 275 __ Waived (Please mark an X for: __Approved Speaker OR __Approved Awardee) AND Are you a: __ Member __ Non-Member __Predoctoral __Accompanying Social COMBINED CPDD/INRC REGISTRATION __ CPDD Member/INRC/Postdocs $ 800 $ 900 __ CPDD Non-Member/INRC $ 950 $ 1125 __ CPDD/INRC Predoc/CPDD MIT $ 650 $ 765 Voluntary Contributions (circle one): Cochin, Eddy, Fischman, Holtzman, Morrison $ ___________________________________ Return Completed Form to: Frosch/CPDD 2015 Attn: Dusty Landwehr 700 Airport Blvd, Suite 360, Burlingame, CA 94010 OR Fax to Frosch at: 650-288-3268 OR Email to [email protected] (if you are faxing/emailing, do NOT mail original form) Registration Questions: Please contact Frosch Global Conferences & Events at 844-849-8159 or email [email protected] Airline Tickets: For assistance with air travel, please contact Teresa Williams at 615-463-4110 or email [email protected] HOTEL BOOKING: Please visit www.arizonabiltmore.com/booking and enter the group code: CPDD to make your hotel reservations. Rates start at $189 per night plus a $15 resort fee & taxes. A 2 night deposit is required. A porterage charge of $12/room and daily $3 housekeeping fee will be applied as well. Book early to ensure availability as hotel rooms are not guaranteed after April 13, 2015. A limited amount of lower priced rooms for Students and Government Employees will be available at the Embassy Suites Phoenix. Please visit www.cpdd.vcu.edu for more information and rate details. Afghanistan Dominican Republic Lithuania Sierra Leone Albania East Timor Madagascar Slovakia Algeria Ecuador Malaysia Slovenia Angola Egypt mali Solomon Islands Anguilla El Salvador Marshall Islands Somalia Argentina Equatorial Guniea Mauritania South Africa Armenia Eritrea Mauritus Sri Lanka Aruba Estonia Mexico Sudan Azerbaijan Ethiopia Micronesia, Federated States Of Suriname Bangladesh Fiji Moldova, Republic of Swaziland Belarus Gabon Mongolia Syrian Arab Republic Belize Gambia Morocco Tajikstan Benin Georgia Mozambique Tanzania Bhutan Ghana Myanmar Thailand Bolivia Grenada Namibia Togo Bosnia & Herzegovina Guatemala Nepal Tonga Botswana Guinea New Caledonia Trinidad & Tobago Brazil Guinea-Bissau Nicaragua Tunisia Bulgaria Guyana Niger Turkey Burkina Faso Haiti Nigeria Turkmenistan Burundi Honduras Oman Tuvalu Cambodia India Pakistan Uganda Cameron Indonesia Palestinian Territory, Occupied Ukraine Cape Verde Iran Panama Uruguay Central African Republic Iraq Papua New Guinea Uzbekistan Chad Jamaica Paraguay Vanuatu Chile Jordan Peru Venezuela China Kazakstan Philippines Vietnam Colombia Kenya Romania Yemen Comoros Kribati Russian Federations Yugoslavia Congo Korea Rwanda Zambia Congo, the Democratic Republic Kyrgystan Saint Lucia Zimbabwe Cote D'Ivoire Laos Saint Vincent and the Grenadines Croatia Latvia Samoa Cuba Lebanon Sao Tome and Principe Djibouti Liberia Senegal Dominica Libyan Arab Jamahiriya Seychelles
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