Registration for North & South American Attendees (USD/$)

14th International Workshop on Scleroderma Research Registration Form

Please complete the form to register for the Workshop. Space is limited, so registrations will be taken on a first-come, first-serve basis. Cancellations must be made by June 12 in order for a refund to be made.

Registrant

Title
Name*
First Last
Position
Department/Division
Institution/Company*
Address*
Street Address Address Line 2 City State / Province / Region Zip / Postal Code Country
Phone*
Email*

Registration Descriptions

Full Scientific Registration includes:
1. Scientific Program
2. Meals (Breakfast, Lunch, Tea & Coffee Breaks)
3. Welcome Reception & Banquet
4. Lodging at St. John’s College
Trainee Registration includes:
1. Full Scientific Registration at a reduced cost for trainees. A supporting letter from your Program Director or PI must be emailed to millie.williams@ucl.ac.uk.
Scientific Registration w/o Lodging includes:
1. Scientific Program
2. Welcome Reception & Banquet

Your Registration*

Full Scientific Registration – $895
Trainee Registration (See instructions above) – $500
Scientific Registration w/o Lodging – $500

Banquet Attendance*

Will be attending the banquet on August 4
Will not be attending the banquet on August 4

The cost of the banquet is included in registration.

Parking

Do you require overnight parking at $11.00 per night?*

Lodging

Do you require lodging?*
- Yes
- No
Please note: Only single, ensuite rooms are available.

Guest Information

Are you bringing a Guest?*
- No Guest – $0
- Yes – Guest Registration with Banquet – $475
- Yes – Guest Registration without Banquet – $410

Name of Guest*
First Last
Guest Registration with Banquet includes:
1. Reception & Banquet
2. Lodging
3. Meals (Breakfast & Lunch)
Guest Registration Without Banquet includes
1. Reception
2. Lodging

Payment Method*

Credit Card
Check

Mail checks to Miss Millie Williams, Centre for Rheumatology, Royal Free & University College Medical School, Royal Free Campus, Rowland Hill Street London NW3 2PF, UK

Refund Policy

Cancellations must be made by June 12 in order for a refund to be made.