Download - Genzyme Center - PIUG

Registration Type

PIUG 2014 Biotechnology Meeting Tuesday, February 25, 2014

Genzyme Center 500 Kendall Street

Cambridge, MA 02142

Boston Marriott Cambridge Two Cambridge Center Cambridge, MA 02142

Call 800-288-9290

617-494-6600 Please mention PIUG 2014 Biotech Meeting Accommodations

when you call for reservation. Reduced Hotel Rates are guaranteed until Friday, February 10th, 2014

CONFERENCE REGISTRATION FORM Before After After

January 22nd 2014 January 21st to February 17, 2014

February 17th, 2014 On Site Amount

Member:

Non-Member:

Student:

Retiree:

Unemployed:

Rates Rates Rates

$95.00 $150.00 $225.00

$190.00 $250.00 $325.00

$50.00 $75.00 $95.00

$50.00 $75.00 $95.00

$50.00 $75.00 $95.00

This is my first time attending a PIUG Conference Yes No Total:

Special Physical or Dietary Needs. If yes, check:

If so, please tell us your special needs: _______________________

May PIUG use your photo in a Piug Newsletter? Yes No

Please tell us, if you are a: Sponsor Sponsorship Complimentary Attendee Speaker

PAYMENT INFORMATION

Please type or carefully print the information requested exactly as it should appear on the roster and participant's name badge. If the participant uses a nickname, please indicate how it should appear on the name badge.

Check Visa MasterCard American Express Discover

Name:

Employer/Affiliate of:

Home Address:

Home City Zip:

Work Phone: Work Fax:

E-mail: CARD HOLDERS INFORMATION

First Name: Last Name:

Billing Address:

City, State, Zip: Zip:

Credit Card Number: Exp. Date: Sec Code (CVV):

Signature of Card Holder:

OUR CURRENT REFUND POLICY

If cancellation is received prior to February 1st, 2014, a full refund will be provided minus a 10% administration fee. No refunds will be provided after February 1st, 2014. Any cancellation must be sent in writing to Ken Koubek at [email protected].

Print this form, attach payment and submit to:

Patent Information Users Group, Inc.

40 E. Main Street, #1438

Newark, DE 19711

Phone: (302) 660-3275

Fax: (302) 660-3276

http://www.piug.org/