42nd 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
_____ Registration Fee for meeting for ACC members $325 US dollars only
_____ Registration Fee for meeting for non-ACC members $400
_____ Student Registration fee for meeting $260
_____ ACC Dues for 2012 & 2013 $100
_____ ACC Dues for student membership for 2012 & 2013 $ 40 (include letter of training status from mentor)
_____ 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:__________________________
________________________________________
