8th Annual Conference of the International Society
for Quality of Life Research ~ November 7-10, 2001
Meeting Registration Form
Thank you for your interest in the ISOQOL 2001 Annual Meeting. While advance registration ended October 22, 2001, you may still print out and bring this completed form with you to the meeting to register on-site.
*
Last Name
*
First Name
Highest Degree
Nickname for Badge
Company
*
Address
*
City
*
State
*
Zip/Postal Code
*
Country
Phone
Fax
Email
Name of accompanying person
Do you require any special accommodations or have special dietary needs?
Registration form and payment must be received by Oct. 22 or you will have to register on-site.
*
Registration fees:
By July 30,
2001
After July 30, 2001
On Site
ISOQOL members
US $300
US $350
US $400
Non-Members
US $400
US $450
US $500
Student*
US $115
US $140
US $180
Training Workshops
Please Enter the Workshop Number (Click
here
to view Workshop descriptions) in the box below to indicate first,second or third Choice. You may choose morning, afternoon or both.
Morning Workshop
1st Choice
2nd Choice
3rd Choice
Afternoon Workshop
1st Choice
2nd Choice
3rd Choice
By July 30,2001
After July 30, 2001
On Site
1 Workshop
US $125
US $150
US $160
2 Workshop
US $200
US $225
US $230
Social Events:
By July 30,2001
After July 30, 2001
On Site
Conference Dinner, Friday
US $75
US $85
US $95
Accompanying Persons**
US $100
US $110
US $120
*
Yes, I will attend the Business Meeting on Thursday, November 8. (Lunch Provided)
*
No, I will not attend the Business Meeting on Thursday, November 8.
*Please provide a letter from your mentor or a copy of your student identification.
**Includes Welcome Reception on Wednesday, November 7 and Conference Dinner on Friday, November 9.
Enter The total Amount :
Please check the desired payment method: (make checks payable to ISOQOL in US dollars)
Credit Card
Check
Money Order
VISA/MC Number
Expiration Date
If paying by check, cash or money order,
please print clearly and return to:
ISOQOL Executive Office,
6728 Old McLean Village Drive,
McLean, VA 22101-3906 USA,
Fax: (703) 556-8729
This form may be reproduced.
