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Online Registration Form

9th Annual Gilbert S. Greenwald Symposium on Reproduction
October 11-12, 2012

Online Registration Form

For questions regarding registration, please email us at GreenwaldSymposium@kumc.edu

All fields are required except those marked with an asterisk (*).

REGISTRANT INFORMATION
   
   
BS MBBS MS MD PhD DVM

REGISTRATION

Register for the Gilbert S. Greenwald Symposium on Reproduction and attend the Keynote Lecture and Poster Session on Thursday, October 11, and all events on Friday, October 12 (includes breakfast, coffee and refreshments during breaks, and lunch on October 12). NOTE: There is a separate fee for the Reception on Thursday, October 11.

Faculty $70
Staff $30
Trainee $30

TRAINEE & SPEAKER LUNCH INTERACTION

On Friday, October 12, at the Kansas City Public Library, Helzberg Auditorium on the 5th Floor, we will designate tables for trainees to have lunch with the symposium speakers. This is an excellent chance for trainees to ask questions, get advice and connect with outstanding scientists doing research in reproduction. The cost of this lunch interaction is rolled into your registration fee, so no additional payment is required to attend!
NOTE: Trainee Lunch Interaction with the Plenary Speakers is for graduate students and postdoctoral fellows/associates only.

Not Attending
Attending

If attending, please rank your symposium speaker lunch table preference from 1-5, with 1 being your top choice.

RANK:

RANK:

RANK:

RANK:

RANK:

RECEPTION

We hope you'll join us for a casual evening of mingling with symposium speakers and colleagues on Thursday, October 11 from 6:30-9 p.m. (immediately following the Keynote Lecture), in the Beller Conference Center on the KUMC Campus. Reception includes heavy appetizers, dessert, wine, beer, soda, water, coffee, etc.

Not Attending Reception
Faculty $30
Trainee/Staff $20

Guest $30
No Guest
Total Due:

Method of Payment

CHECK: Please print this page now and mail the form with check payable to "The Gilbert S. Greenwald Symposium on Reproduction", mail payment to:

Jackie Jorland
University of Kansas Medical Center
3901 Rainbow Boulevard, MS3050
Kansas City, KS 66160

CASH: If paying cash, you can pay at the registration desk upon arrival at the event, or you can drop off cash payments to Jackie Jorland in 3084 HLSIC (KUMC Campus). Please do not send cash via mail.

CREDIT CARD: If paying by credit card, we will send you a link to the Eventbrite website for credit card payment processing. This information will be included in your registration confirmation email.

KUMC Account Number *

CANCELLATION/REFUND POLICY: We understand that emergencies arise and plans change, so we ask that you notify us via email as soon as you realize you will not be able to attend the symposium. This will give us a chance to update our head count with the venue, caterers, etc. If you cancel by Monday, October 1st, we will provide a full refund within 30 days after the conclusion of the event (you should receive your refund by November 12th). After October 1st, we will withhold a $25 administrative processing fee from your registration and return the remainder to you via check within 30 days after the conclusion of the event (you should receive your refund by November 12th). Please contact us via email at greenwaldsymposium@kumc.edu if you have questions about this policy. Thank you in advance for your understanding and cooperation.

*QUESTIONS/COMMENTS?

Once you hit "submit", you will receive a confirmation of abstract submission from greenwaldsymposium@kumc.edu. This is not an auto-response, so if you submit the abstract on the weekend or after hours, the response will come on the next business day.
Last modified: Sep 18, 2012
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