UC Davis Research Retreat on Host Microbe Interaction
GRANLIBAKKEN CONFERENCE CENTER, TAHOE CITY, CA
November 5 – 6, 2015 / Thursday 12 P.M. through Friday 5 P.M.
OFFICE USE ONLY
Date Rec’d ___________
Paid in Full Yes No
Room No. ___________
REGISTRATION AND FEES DUE BY SEPTEMBER 25, 2015
PLEASE PRINT
LAST NAME
FIRST NAME
CAMPUS DEPT
PI NAME
WORK PHONE
CELL PHONE
EMAIL ADDRESS
PLEASE CHECK ONE
Male
Female
The Granlibakken Conference Package includes 1 night’s lodging, 1 breakfast, 2 lunches, 1 dinner, refreshments,
plus the use of all conference and recreational facilities. Any damages will be the responsibility of those registered in room.
CHOOSE ONE
Bedroom/Studio (2 persons) @ 450.00 per person
$
Townhouse (4-8 persons) @ 350.00 per person
$
Single room (1 person) @ 525.00 per person
$
TOTAL AMOUNT ENCLOSED / RECHARGE
$
SPOUSE/GUEST REGISTRATION
Spouse/guest @ $120.00 per person guest fee (includes full conference package)
$
Name of Spouse/Guest: ________________________________________________________
Please submit personal check, money order or cashier’s
check payable to UC Regents for spouse/guest payment.
PAYMENT METHOD (please check one):
Department Recharge Number: ______________________________ (example, must be seven-digit account number: 3-ABCD123
Check Enclosed (please make payable to UC Regents)
IF SHARING ROOM, PLEASE COMPLETE TABLE BELOW:
NAME OF ROOMMATES, ADVISE WHO IS SHARING ROOM.
(TOWNHOUSE USUALLY HAS MULTIPLE BEDS IN EACH
ROOM)
PLEASE INDICATE IF YOU’D LIKE A LOFT. LOFT ROOM IS AVAILABLE IN SOME OF THE TOWNHOUSES, HAS ITS OWN KEY AND OVERLOOKS THE SHARED LIVING SPACE IN TOWNHOUSE. (Townhouse room rate)
IF DOUBLE OCCUPANCY, PLEASE LIST NAMES HERE: ________________________________________________
_________________________________________________________
Check here if you need to be assigned to a room. Please check your preference for roommate:
DIETARY RESTRICTIONS
Check here for dietary restrictions:
Celiac disease (no gluten)
Vegetarian
Peanut Allergies
male
female
Other ____________________________
POSTER SUBMISSION
Check here to submit poster
Poster Title: __________________________________________________________________________________________________________
T-SHIRT ORDER
Check here to order t-shirt
Pay at Conference (Cash or personal check)
Please indicate your t-shirt size:
X Small
(T-shirts will be available for pick-up at conference)
Small
Medium
Payment enclosed (make check payable to UC Regents)
Large
X Large
XX Large
XXX Large
REGISTRATION/CANCELLATION
Complete this form and fax to 530-754-7240 or return with full payment to:
Medical Microbiology and Immunology Department
UC Davis - 3146 Tupper Hall
Attention: Karryn Doyle
Any CANCELLATIONS received after October 29 but prior to November 2 are charged $100.00 per person to the master account. CANCELLATIONS
received after November 2 and no shows are charged the full package rate. Spouse/guest cancellations received less than 72 hours prior to arrival are
charged $25.00 per person. Participants who check in a day late or checkout a day early are charged the full package rate unless the alternate
arrival/departure dates are confirmed 72 hours prior to arrival.
For more information, please contact Karryn Doyle at (530) 752.9401 or Email: kddoyle@ucdavis.edu