BEHAVIOR GENETICS ASSOCIATION
34th Annual Meeting
Centre des Congrθs, 14
Boulevard Carnot, 13100 Aix en Provence, cedex 1
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:
_____________________ Email: ____________________
|
Status |
Meeting |
Before March 15 |
Between March 15 and April
15 |
After April 15 or On site |
Amount
owed |
|
|
Regular Member |
BGA* only |
275 |
375 |
450 |
|
|
|
Regular Member |
BGA + ISDP* |
350 |
450 |
500 |
|
|
|
Student or retired Member |
BGA* only |
200 |
220 |
300 |
|
|
|
Student or retired Member |
BGA+ ISDP* |
290 |
320 |
400 |
|
|
|
Non-member |
BGA* only |
400 |
500 |
500 |
|
|
|
Non-member |
BGA + ISDP* |
450 |
500 |
550 |
|
|
|
Student non-Members |
BGA* only |
250 |
320 |
350 |
|
|
|
Student non-Member |
BGA + ISDP* |
300 |
400 |
500 |
|
|
|
Banquet extra ticket |
|
70 |
70 |
70 |
|
|
|
|
One day |
100 |
100 |
120 |
|
|
Total amount enclosed in Euros
|
||||||
* Includes Monday lunch and
evening reception plus Wednesday BGA banquet
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. Roubertoux to be
received no later than
N.B. Credit
card charges will be made in euros. See http://www.xe.com/ucc/convert.cgi
for rates.
Check Payment: Make checks payable in euros
only to: Behavior Genetics Association
Credit Card Payment: ______ Mastercard ______ Visa (no other cards will be
accepted)
Card Number:__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ Expiration Date:
Name (as embossed on card): _______________________________
Signature: ____________________
Mail
or fax this form with credit card information or check to the Treasurer:
Deborah Finkel, Ph.D.
Tel: 812.941.2668
Department of Psychology Fax:
812.941.2591