Document 6539865

American Society for Virology 2013 Annual Meeting
June 21-25, 2014
Colorado State
University, Fort
Collins Colorado
REGISTRATION
FORM
This form may be duplicated for additional registrations. Please print in ink or type. Return to CSU Office of
Conference Services by June 13, 2014. You can also register online at www.asv2014.com.
PARTICIPANT INFORMATION
Name:
Gender:  Female
 Male
Affiliation:
Address:
City:
State/Province:
Country:
Postal/Zip Code:
Telephone:
Email:
Please list ADA Accommodations / Dietary Restrictions:
Will you be presenting a talk/poster at the meeting?  No
 Yes
REGISTRATION FEES
Graduate Student Fee (until April 21, 2014)
Graduate Student Late Fee (beginning April 22, 2014)
Undergraduate Student Fee (until April 21, 2014)
Undergraduate Student Late Fee (beginning April 22, 2014)
Member Fee (until April 21, 2014)
Member Late Fee (beginning April 22, 2014)
Nonmember Fee (until April 21, 2014)
Nonmember Late Fee (beginning April 22, 2014)
[_] $400
[_] $475
[_] $300
[_] $375
[_] $500
[_] $575
[_]$600
[_] $675
Number of Guest(s) (includes welcome reception and three socials)
[_] $75 x ________
Name of your guest(s): _____________________________________________________________________
An additional charge of $50 will be added to each walk-in registration received after June 13, 2014.
Total for Registration Conference Fees
TOTAL
$
_____
ADDITIONAL EVENTS
ASV dinner (Tuesday, June 24, 2014)
[_] $55
Veterinary Virology Club satellite symposium (Sunday, June 22, 2014)
Plant Virology Club satellite luncheon (Saturday, June 21, 2014)
Medical Virology Club satellite luncheon (Saturday, June 21, 2014)
[_] $35
[_] $65
[_] $65
ASV T-shirt Indicate size:
[_] $15
[_] XSmall
[_] Small
[_] Medium
[_] Large
[_] XL
[_] XXL
[_] XXXL
Total for Additional Events
TOTAL
$
Total for Registration and Additional Events
TOTAL
$
LUNCH DISCUSSION TABLES
As in previous ASV meetings, the Education Committee will sponsor lunchtime topics tables for students and
postdocs. No cost is involved, but seating is limited. If you are interested, please enter the numbers 1-3 to
rank a TOTAL of up to three (3) discussions that you would like to attend (1 is top choice). Attendees
will be chosen by a lottery system and the selected attendees will be notified prior to the start of the
conference to confirm your acceptance.
Sunday June 22, 2014
[_] David Baltimore
[_] Alexander Ploss
[_] Rozanne Sandri-Goldin
[_] Ekaterina Heldwein
[_] Richard Lloyd
[_] Junior Investigator TBA
[_] Junior Investigator TBA
[_] Finding the right postdoc for your career goals
Monday June 23, 2014
[_] Clodagh O'Shea
[_] Michael Imperiale
[_] Maribeth Eiden
[_] Thomas Shenk
[_] PUI/Small College Teaching Careers
[_] I don't want to be a PI, now what?
[_] Finding the right postdoc for your career goals
[_] Balancing work and family
Tuesday June 24, 2014
[_] Jeremy Luban
[_] Michael Gale
[_] Savithramma Dinesh-Kumar
[_] Carla Saleh
[_] Networking, politicking, dealing with difficult colleagues
[_] Balancing work and family
[_] I don't want to be a PI, now what?
[_] Teaching virology
PAYMENT METHOD
Please see registration information for details. Checks/wires must be in U.S. funds payable to: Colorado State University.
*There will be a $17.00 fee charged on checks returned by the bank due to insufficient funds.*
Payment Type
Check
Cash
Credit Card
Card Number
Exp. Date
/
To adhere to Colorado State University’s PCI compliance rules, please DO NOT WRITE THE 3-DIGIT CSC CODE on this form.
Deadline: All registrations must be received by 5:00 p.m. MDT on June 13, 2014. After this date, please call the CSU Office of
Conference Services at 970-491-6222 or via email at conferences@colostate.edu for information about on-site check-in; if space
permits, you can register for an additional $50.
Confirmation: CSU Office of Conference Services will confirm your registration via the email address listed above. You will be
alerted promptly of any cancellations or changes. If some unforeseen event forces CSU Office of Conference Services to cancel or
postpone the program, you will receive a full refund of your registration fee; however, the University cannot be held responsible for
any related costs, including cancellation fees assessed by airlines or travel agencies.
Refunds: If your request to withdraw is received prior to May 20, 2014, we can issue a partial refund. Send your written request via
email at conferences@colostate.edu or by fax to 970-491-3568. A $50 administrative fee will be charged for each withdrawal.
Anyone who is registered but cannot attend may send a substitute.
Access: CSU Office of Conference Services encourages persons with disabilities to participate in its programs and activities. If you
anticipate needing special accommodations or have questions about the physical access provided, please contact CSU Office of
Conference Services at 970-491-6222 at least two weeks prior to the conference.
Mail to: Office of Conference Services
645 S. Shields Street
8037 Campus Delivery
Fort Collins, CO 80523
Phone: (970) 491-6222/Fax: (970) 491-3568
Email: conferences@colostate.edu
www.conferences.colostate.edu