13 – 14 November, 2008 • The Sheraton National Hotel, Arlington, VA, USA

Registration Form

To register please complete and return the attached form. At present we are unable to offer online registration.

Registration Information

Fax to: +44 (0) 1865 843 958
From the US fax to: 011 44 1865 843 958

Or mail completed form to:
Charlotte Wilkins, Stress, Coping and Disease, Elsevier, The Boulevard, Langford Lane, Kidlington, Oxford, OX5 1GB, UK

Delegate Details

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Special access or dietary requirements:

Presenters should provide their abstract reference number in order to ensure that their material is included in the final program and abstract book:
Ref:

Please do not include my name and affiliation in the list of attendees.

Registration Rate

(Please tick required registration)

Industry Registration - US$795
Academic/Author Registration - US$495
Student Registration US$225*
(*The student fee applies to students registered for a full-time higher degree and must be accompanied by a signed letter from your head of department attesting to student status. This rate is not applicable to post-doctoral students.)

Please send me information on sponsorship opportunities at A Brain Research Meeting.

Payment Details

Total payment required US$

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I confirm that all of the above information is correct and that I am the valid credit card holder or authorised to enter into this transaction on behalf of the individual identified above, who is the valid credit card holder.

Declaration

(Please note that unsigned forms cannot be accepted)

I have read and agree to abide by the payment and cancellation terms, and I understand that this form confirms my conference booking. I accept that from now on charges will be imposed for cancelled registrations, and that up to the full registration fee will be payable if I am unable to attend the conference for any reason.

 

Signed:_________________________________________________

Date:_____________

Data Protection Notice: The personal information that you provide on this form will be used by Elsevier Limited, [a company registered in England and Wales with company number 1982084, whose registered office is The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, UK, conferenceinfo@elsevier.com (delegates are reminded not to email credit card information in any circumstances)]  and it’s offices worldwide to process your registration and, with your permission, may be used by us and affiliated and non-affiliated third parties for marketing purposes. We respect your privacy and do not rent, sell or disclose your personal information to any non-affiliated third party without your consent.

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(2008 Media Partners)

NewScientist

New Therapist