| Priority Code: (if known) * |
|
| First Name: * |
|
| Last Name: * |
|
| Title: * |
|
| Department * |
|
| Company: * |
|
| E-mail Address: * |
|
| Telephone: * |
|
| Fax: |
|
| Address 1: * |
|
| Address 2: |
|
| City: * |
|
| State/Province: * |
|
| Zip Code: * |
|
| Country: * |
|
|
Special Dietary Restrictions:
|
|
Please tell us how you
heard about the Drug Development Summit:
|
|
Conference
Fees:
YOUR REGISTRATION FEE INCLUDES ALL CONFERENCE
SESSIONS AND MATERIALS, RECEPTION,
CONTINENTAL BREAKFAST, BREAKS AND LUNCHES.
|
| * Canon Communications
reserves the right to determine registration
type and qualifying rate |
|
| Name of 1st registrant: |
|
| Title of 1st registrant: |
|
|
| Name of 2nd registrant: |
|
| Title of 2nd registrant: |
|
|
| Name of 3rd registrant: |
|
| Title of 3rd registrant: |
|
|
| Name of 4th registrant: |
|
| Title of 4th registrant: |
|
|
|
| Name of 5th registrant: |
|
| Title of 5th registrant: |
|
|
| All registrants will
receive a written confirmation on the receipt
of their delegate registration |
|
I am unable to attend, but
wish to purchase:
Document Book($125)
Online Documentation ($395)
Both ($475)
I am unable to attend, please put me on your
mailing list. |
|
| Hotel Reservations: |
Please contact the Ritz Carlton, Amelia Island at 800-542-8680 to make your hotel reservations. You must make your hotel reservations prior to January 11, 2008 to receive the discounted group rate, and be sure to state you are attending the
Drug
Development Summit. |
| |
| |
|
| Payment Options (please
select one) * |
By Check
Please make checks payable to: R&D Directions
Mail to:
Canon Communications Pharmaceutical Media Group
828A Newtown-Yardley Road
Newtown, PA 18940 |
|
|
American Express
Visa
MasterCard |
| Card Number: |
|
| Expiration Date: |
/
(mm/yy) |
| Name as appears on card: |
|
| ON RECEIPT, COSTS FOR
YOUR REGISTRATION WILL BE CHARGED TO THIS CARD,
UNLESS CHECK ACCOMPANIES REGISTRATION. TEAM
MEMBERS MUST PROVIDE THEIR OWN PAYMENT OR CREDIT
CARD INFORMATION OR ENTIRE TEAM COST WILL BE
CHARGED TO THIS CARD. YOU MAY COPY THE REGISTRATION
FORM FOR EACH TEAM MEMBER TO FILL OUT AND THEN
SUBMIT TOGETHER. |
|
|
By Fax (download form here, and with credit card info filled
out, fax to: 310-996-9499) |
|
Substitution and Cancellation:
Please notify us in writing 10 business days before the event start date if, for any reason, you should be unable to attend. A credit voucher equivalent to the amount you paid will then be issued or, if you prefer, a full refund less a $395 non-refundable administrative fee will be given. For cancellations received fewer than 10 business days before the event start date no refunds or credits will be given. Your registration may be transferred to another individual at any time, but please notify us in writing. When registering, please indicate whether you qualify for a discount. No discounts can be combined. Canon Communications does not accept responsibility for covering travel, accommodation or any other costs incurred by registrants should this event be cancelled for any reason. The event program content is subject to change without notice.
Fields marked with a red asterisk (*)
are required.
Press "submit" button to process.
You will get a confirmation that your information
was received.
|