Surname |
|
Given Name |
|
Mention if you are a student
or an accompanying guest
(in this case, give the name of the participant you are accompanying) |
|
Institute/Company/Organization |
|
Mailing Address |
|
City |
|
Province/State |
|
Country |
|
Postal Code |
|
I wish to attend the conference (no presentation) |
|
I wish to make a oral presentation |
|
I wish to make a poster presentation |
|
I wish to make a oral and a poster presentation |
|
Board |
|
Slides |
|
Transparencies |
|
Video coupled with PC |
Provided as default |
Other |
|
Registration Fees |
Type of Registration |
Prices |
Notes |
Full Registration |
$370 |
See Program |
Student |
$250 |
See Program (must show proof of full academic schedule) |
Accompanying Guest Registration |
$250 |
See Program (must accompany a full registration) |
Individual Event Fees |
15 May 2006 (Monday) |
|
|
Registration Packet/Icebreaker |
$62 |
Includes registration packet and Icebreaker |
16 May 2006 (Tuesday) |
|
|
Conference |
$100 |
Includes registration packet and lunch |
Sea Life Center-Banquet |
$45 |
Includes Admission and Banquet |
17 May 2006 (Wednesday) |
|
|
Conference (includes lunch and Poster Session) |
$110 |
Includes registration packet, poster session, and lunch |
18 May 2006 (Thursday) |
|
|
Conference (includes lunch) |
$100 |
Includes registration packet and lunch |
BBQ Dinner |
$40 |
|
19 May 2006 (Friday) |
|
|
Conference |
$50 |
Includes registration packet |
Option 1 : Cash (USD), Check (U.S. Financial Institution) or credit card at the conference desk |
I will be paying at the Conference Registration Desk (check here) _________ |
Option 2 : Credit card ordering
In this case the following elements are needed |
|
|
|
|
|
- Name imprinted on the card (please print)
___________________________________ |
|
- Billing Address/Postal Code
|
|
|
|
- Signature below (if sending Post or scanned signature):
________________________________________________ |
|
E-mail |
First, don't forget to rename this file <yourname.htm>
Then, send it to gfdurocher@usgs.gov |
Phone |
1.907.786.7009 (USA) |
Secure Fax |
1.907.786.7036 (USA) |
Post mail |
Greg Durocher
9th Circumpolar Symposium
4230 University Drive, Suite 101
Anchorage, Alaska 99508-4664
U.S.A. |
Participants are required to secure their own accommodations for the symposium. A block of rooms will be available at a discounted price at the Windsong Lodge, Seward, Alaska, USA. For room registration via fax, please call 1-907-263-5559. This number goes to the main registration office and is a secure fax.
Guests should call the United States at 1 907 265 4501 no later than 15 March 2006 to be assured a special room rate of (all in USD): of $116.00 per day for a single or double, $131 for a triple, or $146 for a quadruple. Rooms reserved after 15 March 2006 may be charged a higher fee. At the time of booking, guests should include the following information:
- Given and Surname (first and last names) of all guests staying in the room
- Ages of any children
- Any special dietary requests or restrictions
- Any other special requirements
Room fees may not be split between two or more individuals. At time of reservations, guests are required to provide payment by credit card for the length of stay, plus applicable taxes and/or fees. Upon checkout from the Seward Windsong Lodge, guests will be required to pay all outstanding balances charged to their rooms.
Total estimated cost for the Symposium registration and lodging is $950 USD. |
