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Registration Form 2009
April 7-8, 2009
Asilomar Conference Center

800 Asilomar Boulevard
Pacific Grove, California 93950
http://www.visitasilomar.com/

Registration Deadline: February 23, 2009
Registration Fee: $50 (meals & lodging)

  
Please complete the online registration form. Please note, if you are staying an additional night on April 8, there will be an additional charge of $25.
If you would like to attend the IRM Retreat, please register for it separately at http://irm.ucsf.edu/News/Retreat.aspx  by February 13.

Retreat Information | Recharge Form | Directions & Map | Program Agenda

Personal Information (* Required Field)
Title: *
Gender: *
First Name: *
Last Name:*
Email:*
Telephone: * - -
Department: *
Address: *
City: * State: *
Zip Code: *

T-shirt size

If you're a Postdoc Fellow or student, please complete below:
PI's Name:
PI's Email:
Will you present a Poster? Deadline: February 23, 2009

Yes (please provide the title of your poster below):

No

Lodging Information:

Do you need to stay overnight? Note: First-come/first-serve basis.

Yes (please list the order of roommate preferences below)

1.

2.

3.

No

Will you stay for the Keynote Speaker and the IRM Poster Session on the evening of 4/8?

Yes

No

Will you need a room for the evening of 4/8 (please note there is an additional $25.00 charge)?

Yes

No

Emergency Contact Information (* Required Field)
In case of EMERGENCY, please notify:
Name:*
Relationship:
Daytime Phone: *
Evening Phone: *
Payment Method (* Required Field)
How would you like to pay for the registration fee? *

Check (Make check payable to UCSF Regents & mail it to)

UCSF Diabetes Center
C/O Amy Lam
513 Parnassus Ave., Box 0534
San Francisco, CA 94143-0534
Tel#: 415.476.1609 Fax#: 415.731.3612

UCSF Recharge (download Recharge form below)

>> Recharge Authorization Form <<

Request waiver (Note: Fees are waived on a case-by-case basis.)

If you would like to register for the IRM Retreat, please do so at the following link by February 13, http://irm.ucsf.edu/News/Retreat.aspx.

Retreat Information | Recharge Form | Directions & Map | Program Agenda