Exhibitor Registration

Exhibitor Registration Form

42^nd BIENNIAL AMERICAN CYTOGENETICS CONFERENCE

April 19-22, 2012

Hyatt Regency Hotel, San Antonio, Texas

 

Registrant Information:

 

Name: _____________________________________________________                                                                                                         

             First                            Middle                           Last

Address: _________________________________________________

                        Institution    

               _________________________________________________

                        Street Address

City:       _________________________________________________

State/Country:  _____________________________ Zip/Postal Code: ______________

E-mail: ___________________________________  Phone:  _(_____)________________

Meeting Information and Registration Options:

 

The regular meeting registration fee includes: Opening reception, Friday evening Distinguished Cytogeneticist event, continental breakfasts and coffee breaks, Saturday boxed lunch, Saturday closing party and entertainment

 

_____ Registrant included in Exhibitor Fee (one registrant inc)    $    0

_____ Registration Fee for additional exhibitor registrants                    $150    US dollars only

            (one exhibitor registration is included with the exhibitor fee)

_____ ACC Dues for 2012 & 2013                                                     $100   

_____ Optional Activity Fee (see below)                                  ___________

                                                                        Total Due: $   ___________ US dollars (pls pay in US dollars)

 

Optional Activity Registration – Please indicate the activity below and enter the costs for this activity on the line above.  Sorry, you can only choose one.  Space is limited so register early!

_____ Calavaras/Braunig Lakes Fishing Trip                                         $ 60.00

           Botanical Gardens Plant and Bird Walk                               ACTIVITY FILLED

           McNay Art Museum (inc Andy Warhol exhibit)                  ACTIVITY FILLED

 

Please make checks payable to: American Cytogenetics Conference and mail to the following address: 

 

 

Sue Ann Berend, PhD, FACMG

Secretary/Treasurer, American Cytogenetics Conference

Xact Genetics, LLC

29609 Eagle Station Dr

Wesley Chapel, FL 33543

Cell (505) 690-8357

Fax  (813) 385-0960

SueAnnBerend@msn.com

 

If you would like to pay be Credit Card (pls circle which), please enter the following information and send to the address listed on the left:

 

Visa     or      Mastercard

Name on card:___________________________

Card number:____________________________

Expiration Date:__________________________

Billing Address:__________________________

________________________________________