Please enter your name (First, Middle Initial, Last) : 

Position:

P.I.  Postdoc  Student

Institution:

Address (Line 1) : 

Address (Line 2, if any) :

City/State/Zip Code: 

Country:

Telephone:

Fax:

Email Address:

Mode of Transportation:

Plane  Car  Train

Topic or Area of Interest: 

I will not be able to attend the conference without financial assistance 

If this box is checked, please provide an abstract, a description of your current status and a letter of recommendation from a mentor or colleague. Preference will be given to young investigators whose mentors are registered for the meeting.

Title of Abstract (limited to 100 characters):

Abstract: 

*Please note that most of the abstracts submitted here will be considered posters (size 4'x4'). Only a chosen few will be oral presentations at the conference.

**From the Graduate and Postdoctoral Fellows, those with the 8 most outstanding abstracts will be chosen to receive FREE registration (room and board) for the conference.

***We encourage you to attach your abstract via email to carmen@wadsworth.org in order to fully preserve the format you have used, but for those people who don't have such facilities, we also welcome you to enter it in plain text below. Please include in the abstract all the authors and their affiliations as well. The entire length is limited to 300 words.

On-Site registration ($525: 3 nights of double room accommodation, meals, and local transportation)
	Gender:	MaleFemale
	Share room with:
	*There are a limited number of single rooms available for an additional $100. However, since there are not enough such rooms, some have to be accommodated in doubles. Therefore please fill out room sharing option, as well.
Off-Site registration ($140: lunch and snacks only.)
	(Additional meals are at the cost of $25 per dinner and $7.50 per breakfast.)

Other Requirements

	Vegetarian:	No Yes
	Dietary Restrictions:
	Special Assistance:

Payment Information

 

	Paying by:	Credit CardBank drafts
	Total:	$525, Standard double room package$625, Single room package$140, Off-Site

* Payments other than credit cards must be drawn on U.S. banks in U.S. dollars payable to The Albany Conference Foundation. Directions for payments are on the next page after you submit this form. If prepaying, please send your payment by September 1st, 2000.

Thank you for registering with us, please submit this form now. 

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