Congress Registration

This is the early registration form for ANAEROBE 2004, to be held July 18-21, 2004 in Annapolis, MD USA. Early registration is strongly advised as attendance will be limited. Confirmations will be sent to you via e-mail and in your delegate packet preceding the Congress.

REGISTRANT
Name: Degrees:

MAILING ADDRESS







CONTACT INFORMATION
Tel: Fax:
Email:

REGISTRATION FEES

On-line registration is available with credit card payment. Payment with checks and for students must be done by mail. No advance registrations will be accepted after July 9, 2004

Congress Registration includes Delegate packet, Abstract Book, admission to Congress sessions and poster areas, Continental breakfast, coffee breaks, Monday evening reception. Full registration also includes the Congress Banquet with transportation on Tuesday evening. Additional dinner tickets may be purchased separately.

Before
May 15, 2004 		After
May 15, 2004
ASA Members
Full Package (including Banquet)
Meeting Attendance Only

Non-Members
Full Package (including Banquet)
Meeting Attendance Only

Single Day
Days: Monday Tuesday Wednesday

Student (send a copy of current ID)
Meeting Attendance Only

Number of Extra Banquet Tickets		 $230
$170


$300
$240


$80 per day


$80

$65 each 		$270
$210


$340
$280


$100 per day


$90

$70 each

Continuing Education Units:
Category I CME - 15 hours -- $15
Laboratory Technicians - 15 hours -- No Charge
None

Sunday, July 18 Pre-Congress Workshops: Anaerobic Bacteriology for the Clinical Laboratory
Anaerobic Identification & Susceptibility -- $75 ($85 after May 15)
Molecular Techniques -- $75 ($85 after May 15)
Both Workshops -- $125 ($135 after May 15)
Cancel Workshop Registration
Number of Anaerobic Bacteriology Manuals (6th edition) -- $36 (beforeMay 15, 2004)

Hotel Reservations

Loews Annapolis Hotel - 126 West St., Annapolis, MD USA www.loweshotels.com
Room Rates: For Saturday night, July 17 - $179 + tax for Workshop participants)
For Sunday night, July 18-Wednesday night, July 21 - $129 + tax per night

Arrival Date: Departure Date:

Number of Beds
Smoking Non-Smoking

For guaranteed hotel rates, registration deadline: May 15, 2004.
Hotel Reservations will be guaranteed to the credit card number below.
A credit card imprint will be required upon check-in for payment.
For special arrangements, contact the hotel directly.
Hotel reservations can be cancelled by contacting the hotel directly.

CREDIT CARD PAYMENT

VISA - MASTERCARD - AMERICAN EXPRESS

Number:   Expiration MM/YY: