Registration

Advanced Registration must
be paid and postmarked by April 15, 2008.

PERSONAL INFORMATION:
First Name:
Last Name:
Designation:	Other:
Institution:
Street Address:
City:
State:
Zip:
Country: (if not U.S.A.)
Telephone:
Fax:
E-Mail:

NAME BADGE INFORMATION:
Name on name badge:	(e.g., Jane A. Doe, M.D. or Mr. John Smith)	What's this?
City, State or Country on name badge:	(e.g., Atlanta, GA or Toronto, Canada)	What's this?
Attendant's First Name:	(if applicable)
Attendant's Last Name:	(if applicable)
Guest's First Name:	(if applicable)
Guest's Last Name:	(if applicable)
Please check if applicable: Speaker Poster Presenter Moderator
Check here for special needs: Accessibility Dietary

PRICING INFO	By 4/15	After 4/15	After 5/16
ASIA Member, M.D. or PhD	$400.00	$500.00	$600.00
ASIA Member, Other	$325.00	$425.00	$525.00
Non-Member	$500.00	$600.00	$700.00
Students, Fellows, Residents (with written verification from department chair)	$275.00	$350.00	$425.00
Single Day Admission	$200.00	$250.00	$300.00
Exempt from Payment for meeting	$0.00	$0.00	$0.00

Add your extras:
Attendant (includes all food and beverage & Presidential Reception)	$100.00	$100.00	$100.00
Guest (Presidential Reception only)	$50.00	$50.00	$50.00
Pre-Course	$100.00	$100.00	$100.00

Discount Code:		How do I get a discount code?

Pay by:

Credit Card
Check
Exempt

I am registering/paying for someone else.

Your Name:

Please be sure to review the above information for accuracy BEFORE clicking Submit.

Refund and Cancellation Policy:
Registration cancellations WILL NOT be accepted by phone.
Cancellations MUST be in writing.

A $75 fee will be assessed and the balance refunded for cancellations postmarked through April 15, 2008.
NO REQUESTS FOR REFUNDS WILL BE ACCEPTED AFTER APRIL 15, 2008.
Refunds will not be issued until after the meeting.
Partial or full fees that have been forfeited cannot be applied to subsequent years.