2006 AAI Advanced Course in Immunology
Registration/Accommodations Form
 Please complete the following information.  Form may be filled in on the screen and printed.

First Name*  

Last Name*  

Institution*  

Address  

City, State, ZIP  

Country  

Phone  

FAX  

E-mail address  

Gender

 M   F

I give permission for the above information to be printed in a course directory: Yes No
* Full name and institution will appear on name tag
REGISTRATION FEES -- Includes all course materials and coffee breaks.  As a privilege of membership, AAI Regular Members in good standing at the time of registration are granted a $50 discount.  Please check the following boxes as applicable:

$ 510  Graduate Student (must complete and submit AAI Trainee Certification Form**)
$ 615  Post doctoral (must complete and submit AAI Trainee Certification Form**)
$ 745   Regular / Academic   Non-profit    Government
$ 1,525   Industry / Corporate

** Download AAI Trainee Certification Form here.

ACCOMMODATION / COMMUTING FEES -- Please check the following boxes as applicable:

Dormitory Occupants
$ 915 per person
      $835 plus $80 refundable room deposit		  Single occupancy
 (Breakfast, lunch, dinner included)
$ 810 per person
      $730 plus $80 refundable room deposit		  Double occupancy
 (Breakfast, lunch, dinner included)

 Commuters

$ 235  Commuter Fee A
 (Lunch and dinner only. Sun.-Fri.)***
$ 100  Commuter Fee B
 (Lunch only. Sun.-Fri.)

*** Commuter students are encouraged to sign up for lunch service as faculty will be invited to attend our lunches to further discuss Immunology.

 

Total of amounts checked above

Less member discount ($50), if applicable

Total payment enclosed****  

**** Accepted forms of payment: personal check, corporate check, money order (credit card payments are not accepted).