Behavior Genetics Association

33rd Annual Meeting

Palmer House Hilton, Chicago, Illinois, USA

June 25-28, 2003

 

MEETING REGISTRATION FORM

 

Please provide your name and affiliation as you would like them to appear on your name badge.

Name:

     

Affiliation:

     

Mailing address:

     

     

Phone:

     

Fax:

     

e-mail:

     

 

Membership Category: (choose one and enter amount in box to the right)

Registration Fee
(in US dollars)

Early Registration Deadline:

March 1, 2003

Late Registration Deadline:

April 1, 2003

Very Late or On-Site:

After

April 1, 2003

 

Regular, non-student member

$300

$350

$450

     

Student or retired member

$200

$250

$300

     

Non-member

$400

$450

$550

     

Single day registration

 

 

$200

     

Extra banquet ticket

 

 

$75

     

TOTAL AMOUNT ENCLOSED:

$0.00

Registration fee includes reception, annual banquet (except for on-site single day registration), coffee breaks and other meeting expenses.  For members not current on dues:  registration fees must be paid at the non-member rate.

To cancel an advance registration, registrants must send a written request to Dr. Heath to be received no later than May 15, 2003.  A $100 processing fee to cancel the registration will be deducted.

 

Payment by check:  Payable in US dollars to: Behavior Genetics Association.

Credit card payment:               

Card type:

Mastercard

Visa

(no other cards accepted)

Card number:

     

Exp date:

     

Name on card:

     

 

Signature and date:

 

HOTEL RESERVATION FORM

 

To be completed for ALL reservation requests for the Palmer House Hilton.

DEADLINE: MAY 15, 2003

Rooms are limited and may sell out before the deadline.  Please return request ASAP.

 

 Single ($140/night)      Double ($160/night)

                Rates quoted in US Dollars.  All rates subject to 14.9% room tax.

 

CANCELLATION POLICY:  Accepted until 45 days prior to arrival.  Cancellations less than 45 days prior to arrival will be subject to penalty.

 

If applicable, name of roommate(s):

     

 Reserve under my name    Reserve under roommate’s name

 

Arrival date:

     

Departure date:

     

 

Credit card will be used for hotel guarantee only.  Checks not accepted for guarantee.

 Please use credit card information provided for registration

 Please use information below for guarantee

 

Card type:

Mastercard

Visa

 

Card number:

     

Exp date:

     

Name on card:

     

 

Signature and date:

 

 

Comments:

     

     

 

Return this form with payment to:

BGA: Attn: Andrew Heath, D. Phil.

Dept. of Psychiatry

Washington University School of Medicine                                    Phone:                                    314-286-2297

40 N. Kingshighway, Suite One                                    Fax:                                    314-286-2213

St. Louis, Missouri 63108                                     e-mail:                                    bga@matlock.wustl.edu