Registration Form

Registration Form

17th International Conference on Aquatic Invasive Species

Registration fees can be paid by check (payable to ICAIS), credit card, bank transfer or purchase order. To register for the conference please print this form, complete it and either return by fax or mail along with your preferred payment option to the Conference Administrator as indicated below. Credit card information cannot be processed on-line. Please note that for credit cards with currencies other than $USD, the fees will be converted to the currency of the card at the applicable exchange rate at the time the transaction is processed.

Conference Administrator
1027 Pembroke Street East, Suite 200
Pembroke ON K8A 3M4 Canada
North America: 1-800-868-8776
International: 613-732-7068
Fax: 613-732-3386
Email: Elizabeth@theprofessionaledge.com

Title

First Name & Initial*

Last Name*

First Name for Badge*

Business Title

Organization/
Affiliation*

Postal Address*

City*

State/
Prov*

Zip/Postal Code

Country*

Business Phone*

Fax

Email*

Web URL

Special Needs

Food Allergy

Vegetarian

Vegan

Other, please specify:

Comments

Privacy Policy: Please indicate by checking the appropriate box to confirm whether or not you accept to have your name, organization and e-mail address included in the Conference Participants list that will be provided to all participants.*

Yes

Registration Fees
SessionChair/Speaker/Poster Presentation	$450 USD
Conference Participant	$550 USD
Full-time Student/Retiree	$350 USD

If you are paying by electronic bank wire transfer, there is an additional service charge of $30.00 USD/CAD, please add that to the applicable fee.

Credit Card Payments

Please note: This is not a secure server. To pay by credit card, please complete this form online (except for credit card details, print it and fax or mail to the Conference Administrator as indicated below.

Card Type

Visa

MasterCard

Card Number

__________________________________________________

Name on Card

_________________________________________________

Expiry Date

_________________________________

Refund Policy
Registration fees are refundable, less a $50 administration fee, provided that written notification of cancellation is provided to the Conference Administrator at the address indicated above by July 30 , 2010. Refunds will not be issued until after the conference.

*Indicates required information