Home > Ion Channel Retreat 2012 > Ion Channel Retreat 2012 Registration

10th Annual Ion Channel Retreat

Vancouver BC, Canada

More information on the 10th Annual Ion Channal Retreat coming soon!

Please fill out the form below to register

*Salutation/Title:
*First Name:
*Last Name:
*Job Title:
Department:
*Direct Phone: ex. 123456789 no dashes only numbers
*Direct Email Adress:
Direct Fax: ex. 123456789 no dashes only numbers
*Company Name:
Street Address:
Town/City:
Postal/Zip Code:
*State/Province: US & Canada only - write 'non-us/can' if not applicable
*Country:
Preferred form of payment:

note: A retreat representative will contact you shortly to discuss your method of payment, please do not provide your credit card information on this form.

PAYMENTS MUST BE RECEIVED FIFTEEN (15) BUSINESS DAYS PRIOR TO THE CONFERENCE

Register online and pay before March 31 for early bird registration fees of USD$799
(Academic or Government USD$449).
Registration fees after March 31 will be USD$899.
(Academic or Government USD$499).

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A printed attendee list will be distributed following the conference to all attendees that opt in. This will contain the following basic information: Name, title, company affiliation, email and country.

Please share my information with my fellow attendees: YES or NO.

Other Requests or Comments:

Register by Phone:
To register by phone, or for additional information, please call AuroraBiomed at 604.215.8700

Payments:
The registration fee for this Conference includes all breakfasts, lunches, refreshments and a banquet. Payments may be made by company check, Visa, MasterCard or Purchase Order. Please make checks payable to Aurora Biomed Inc. and make sure to write the name of the registrant on the face along with the Conference Name.