The Waltham International Nutritional Sciences Symposium

September 15-18, 2005

The Omni Shoreham Hotel -Washington, DC

ADVANCED REGISTRATION FORM

Three Ways to Register
1) Register On-Line
http://conferences.ucdavis.edu/INSS
Credit Card &UC Recharges only.
2) Register by FAX
Complete this form and FAX to: (530) 752-5791
Credit Card Payments Only
3) Register by Mail
Mail completed form & payment to:
Conference & Event Services
Attn: INSS
University of California, Davis
One Shields Avenue
442 Memorial Union
Davis, CA 95616
CANCELLATION POLICY:
Cancellations must be received in writing no later than
Friday, September 2, 2005
Cancellations received prior to this date are usually processed after the conclusion of the conference and will be refunded minus a $40
non-refundable administrative processing fee. Cancellations received after Friday, September 2, 2005 will not be processed or refunded.
Mail/Fax Cancellations to:
Conference & Event Services
Attn: INSS
University of California, Davis
One Shields Avenue
442 Memorial Union
Davis, CA 95616
Fax: (530) 752-5791
Americans with Disabilities Act
If you will require aids or services at this meeting, please forward a letter stating your request to the address indicated above.
Questions?
Contact:
Phone: (530) 752-0198 / Name and affiliation will appear on name badge. Print legibly or type. One form per registrant.
Name:
First Name / MI / Last Name (Surname)
Organization/
Affiliation:
Title:
I would like my badge to read:
Address:
Street Address
City / State / Zip Code / Country
Phone: / () / Fax: / ()
Please include area, city and country codes / Please include area, city and country codes
Email:
Required for confirmation purposes, participation roster and receipt.
Registration Information
Full registration includes admittance to the scientific presentations on September 15-18th, 2005, Saturday night gala dinner, printed program, abstracts and refreshments.
Please note registration does NOT include housing.

Registration Fee Per Person

/ Total
Students/Residents / $75 / $
Delegates (general registration) / $200 / $
*Industry
(Please note: Industry registration payments are nonrefundable) / $300 / $
Journalists, Cornell, and UC Davis Academic Community
Please be prepared to provide verification / No Charge
Genomics Day Only (September 17 & 18) / $75 / $
Extra Copy of the Conference Proceedings / $15 / $
Conference Proceedings (if you will not attend the conference) / $15 / $
Conference Questions
1. Please indicate any special dietary restrictions:
2. In case of emergency, please contact (name & phone):
3. I plan to attend the following special session features (both may be checked):
Advocacy Day (September 16) Yes No
Genomics Day (September 17 & 18) Yes No
Payment Information

We do not accept Purchase Orders, nor do we issue invoices for conference registrations.

Enclosed is my check/money order made payable to "UC Regents"

Any UC Campus Recharge Account (Include full DaFIS Acct, Sub Acct., Dept, Acct. Manager and phone number)
Please charge my: / VISA / MasterCard / American Express / Discover
Credit Card Number / Expiration Date
Name of Card Holder (as it appears on card) / *Signature of Card Holder
**Registration Form will not be processed without the signature of the cardholder.

Registration Confirmation: Once your registration form has been processed, you will receive confirmation by Email. This confirmation will include an official University receipt (receipts will not be handed out on-site at the conference). If you have not received an Email confirmation ten (10) business days after submitting your registration form, please contact Conference & Event Services at (530) 752-0198 or to inquire on whether your registration form was received