REGISTRATION FORM

RETURN by snailmail by December 2 1996 to:
Dr. C. G. dos Remedios,
Dept. Anatomy & Histology F13,
Univ. Sydney, Sydney 2006 Australia

Family Name:...........................................................................................

Other Names:...........................................................................................

Mailing address:
.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

Email Address:..................................................................................................

Phone:...............................   Fax:...............................

Registration Fee

By December 2:                          US$400

After December 2:                       US$450

Financial Assistance

It is our intention to provide some assistance for all attendees. Checks will be presented at the end of the meeting.

If you are a young investigator and/or wish to apply for financial

assistance in this category, please check

Are you currently a PI on a grant from the NIH (R01) or NSF? Please check

Payment

I have enclose a check in US currency payable to ASB Actin Meeting or
I wish to pay by Visa/Mastercharge credit card (we have no facility for American Express).
We do not recommend that you transmit your credit card account number by email. Please fax it.

Name on Card: ..................................................................................................

Card Number:...............................................................................................

Expiry Date: ...................

Registration (before December 2) US$ 400
I wish to attend the Luau (US$ 50 per person) US$ 50 x ..... person(s) = ..............US$

Total US$ ...........................

ACCOMODATION REGISTRATION FORM

To be made directly to ALL ABOUT TRAVEL
Attention to: Deanne Enos
ACTIN Conference
FAX: +1 808 955-3330
PHONE: +1 808 942-1625

Please reserve my accommodation at the

Maui Sheraton Hotel (US$ 150/person deposit by Dec 1 or $300 thereafter)

Islander Hotel (US$ 150/person deposit by Dec 1 or US$ 300 thereafter)

I will be accompanied by ...............................
(up to 2 children under 16 years share free)

I want you to arrange my inter-island transfers                                                 

I wish to share a room                                                                                                  
                        with.................................................

Please arrange for me to share a room

Accommodation deposit US$...........................

Payment

I have enclose a check in US currency payable to ALL ABOUT TRAVEL, Actin Conference or
I wish to pay by Visa/Mastercharge credit card (we have no facility for American Express).
We do not recommend that you transmit your credit card account number by email. Please fax it.

Name on Card: ..................................................................................................

Card Number:...............................................................................................

Expiry Date: ...................

Note that FULL PAYMENT must be made by January 31, 1997. A full refund will be given until time of final payment on January 31. Thereafter, one night's hotel cancellation fee if cancelled up to February 28, and two night's cancellation if cancelled up to March 15. Thereafter, hotel refunds will only be made if the rooms can be resold.
Hotel payments can be made by credit card. All other travel arrangements are made by check or cash, unless International air tickets (which can be made using credit card).

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