Please Print in Block Letters Or Type and Send by Fax, E-Mail Or Post To

Participant Registration Form

Please print in block letters or type and send by fax, e-mail or post to:

The Macrae Foundation Email:

Registration DepartmentFax: +1-866-875-0614

PO Box 3711Telephone: +1-678-615-0132

Rancho Santa Fe, CA USA 92067

Contact Information:

Name:

Last Name (family name) First Name (given name)Degree

Affiliation:

Company NameDepartment

Address:

CompanyStreet Address

City, StateMail CodeCountry

Telephone: / Fax: / Email:

Participant Registration Fees:Registration fee includes entrance to all Symposium sessions, symposium materials including abstract flash drive, symposium folder, Welcoming Reception, Poster Session Reception, and all coffee breaks.

Registration Type / Fee / Deadline Date
Early / $ 895.00 USD / By December 15, 2013
Regular / $ 1,200.00 USD / December 16, 2013 - February 17, 2014
Late / $ 1,375.00 USD / February 18, 2014 – March 3, 2014
Onsite / $ 1,425.00 USD / After March 3, 2014– Onsite only

Student Registration Fees: If applying for the student rate, submit copy of current student ID or statement from the registrar with your registration form. Registration fee includes entrance to all Symposium sessions, symposium materials including abstract flash drive, Welcoming Reception, Poster Session Reception, and all coffee breaks.

Registration Type / Fee / Deadline Date
Student / $ 550.00 USD / By December 15, 2013
Student / $ 600.00 USD / December 16, 2013 – February 17, 2014
Student** / $ 675.00 USD / February 18, 2014 – March 3, 2014
Student** / $ 675.00 USD / After March 3, 2014 – Onsite Only

Accompanying Person:

Name:

$75.00USD Welcoming Reception, March 13, 2014

$ 35.00USD Poster Session Reception, March 14, 2014

Payment:

Please indicate the amount enclosed and preferred mode of payment. Ensure that you send the fully completed form together with your payment:

Option 1: Credit Card: (Charges will be done in USD)

Visa MasterCard American Express

Number:
Expiration Date (month/year):
Name on card and billing address if different from above:

Option 2: Bank Transfer - Please contact The Macrae Foundation () for the wire transfer form and information. A wire transfer fee of $45.00 USD will be assessed.

Option 3: Check or Money Order – Please send check or money order (in USD, payable to a US Bank) to: The Macrae Foundation,PO Box 3711, Rancho Santa Fe, CA USA 92067

Fees Due:

Registration Fee:
Accompanying Person Fee:
Wire Fee:
Total Due:
REGISTRATION CANCELLATION POLICY
All cancellations should be faxed, electronically mailed or post-marked. Refund of registration fees will be as follows:
*Cancellations received up to January 15, 2014 - full refund less $125.00 USD handling fee
*Cancellations received from January 16, 2014 - February 17, 2014 - 50% refund
*After February 17, 2014 - no refund will be made

Please check if you do not wish to be on our mailing list for future symposiums.