2015 ISPE Annual Meeting
ISPE
Registration Form
Philadelphia, Pennsylvania
8 - 11 November 2015
Philadelphia Marriott Downtown
Philadelphia, Pennsylvania
PLEASE TYPE OR PRINT CLEARLY.
Full Education Delegate Fees
ISPE ID# _____________________ £ First-Time Attendee £ New Member
Type
ON or BEFORE AFTER
11 October
11 October
Member
US $1,950
US $2,150
Registration + Membership
US $2,230
US $2,430
Nonmember
US $2,330
US $2,530
Committee
US $1,465
US $1,615
Government
US $700
US $700
Student Member
US $200
US $200
JOB TITLE
Academia Member
US $1,465
US $1,615
Young Professional
US $1,465
US $1,615
EMAIL ADDRESS
One-Day Education Fees
FIRST NAME
MI LAST NAME
INFORMAL BADGE NAME
Type
COMPANY
11 October
11 October
Member
US $749
US $849
Nonmember
US $949
US $1,099
Select One Only: £ MON £ TUES £ WED
Please NOTE:
• Sunday Opening Keynote is open to all.
• Tuesday Night Party is not included in One-Day Registration.
• For a full list of items included in Education Fees, please visit
www.ISPE.org/2015-Annual-Meeting.
• No refunds after 18 October
BUSINESS ADDRESS
CITYSTATE/PROVINCE
ZIP+4/POSTAL CODE
ON or BEFORE AFTER
COUNTRY
BUSINESS TEL
A La Carte Event Fees (items below are not
included in the registration fee except where
indicated)
EMERGENCY PHONE
Event Type
Sunday Opening Keynote (Open to all)
Fee
US $0
Sunday Welcome Reception (only included with
Full Registration)
US $50
Monday Lunch in Exhibit Hall (included in Full
and Monday-Only Registrations)*
US $60
Monday Reception in Exhibit Hall (included in
Full and Monday-Only Registrations)
US $35
Monday Young Professionals Networking Event
US $58
Monday 5K Charity Run/Walk
US $25
£ CELL PHONE £ HOME PHONE
Ways to Register:
4
ONLINE:www.ISPE.org
PHONE: +1-813-960-2105
FAX: +1-813-264-2816
MAIL:
ISPE, 600 N Westshore Blvd, Suite 900
Tampa, FL 33609-1114 USA
#
Tuesday Membership and Awards Breakfast
US $45
(included in Full and Tuesday-Only Registrations)
PAYMENT METHOD:
Registrations require payment attached
Check enclosed payable to ISPE # __________________
in the amount of $ __________________ (Must be drawn on a US bank)
Bill credit card (check type): £ VISA £ MasterCard £ American Express
CARD NUMBER Attendee
plus
Guest
EXP DATE
NAME OF CARDHOLDER (AS IT APPEARS ON CARD)
CARDHOLDER SIGNATURE
Questions?
Contact ISPE Member Services at ask@ISPE.org or
+1-813-960-2105.
Tuesday Lunch in Exhibit Hall (included in Full
and Tuesday-Only Registrations)*
US $60
Tuesday Night Party (only included with Full
Registration)
US $200
Wednesday Facility Tours (3 Tours Available)
Tour 1 $50, Tour 2 $85, Tour 3 $85
Visit Website for Details
US $50
US $85
US $85
TOTAL
Fees are based on per-person pricing. If you are inviting a guest please list name below, add to the
count in the attendee plus guest column and adjust price accordingly.
*Special Lunch Requirement: £ Vegetarian £ Kosher £ Gluten-Free £ Allergy
Guest Name_________________________________________________
Registration is confirmed only when payment is received.
To wire payment in US Dollars:
Wells Fargo Bank NA
San Francisco, CA USA SPE Acct #2000027075566
ABA #121000248
FEI#59-2009272