DEADLINE FOR RECEIPT OF ADVANCE REGISTRATION IS 6/12/2015 19th Annual Green Chemistry & Engineering Conference July 14-16, 2015 Bethesda North Marriott Hotel - North Bethesda, MD http://gcande.org Name (Last, First): Company/University: Street Address: City, State, Zip: Phone: Fax: Email: Academia Industry Government Student Other ___________________ Is this your first Green Chemistry & Engineering Conference Yes No Are you a Speaker or Poster presenter? YesNo (All speakers and poster presenters must register in the appropriate registration category.) Please note: An attendee list will be provided to all registered attendees after the conference with your name, affiliation/company, address, phone number and e-mail address. Please provide your business information. To opt out of having your information provided, please check here: Yes, subscribe me to The Nexus – A monthly newsletter published by ACS Green Chemistry Institute® dedicated to connecting and expanding the global green chemistry and engineering community. Yes, I would like an invitation to attend the Presidential Green Chemistry Challenge Awards Ceremony & Reception on Monday, July 13 at 4:00pm at the National Academy of Sciences. You will be sent an invitation if space permits. Transportation not provided. Registration Full Conference Registration One-Day Registration Day: T / W / TH Student Registration* 50-year ACS Member Guest Registration** Guest Name(s): circle choice Advanced Rate Jan. 15 – June 12, 2015 $550 $295 $200 $200 $20 ea. Standard Rate Begins June 13, 2015 $650 $345 $225 $225 $20 ea. * Student registration applies to registered undergraduate, graduate and post-doctoral students (Student ID reqd) ** Guests may not be involved in the green chemistry or green engineering industry Ticketed Events Tuesday, July 14 - Continental Breakfast Tuesday, July 14 - Networking Luncheon Tuesday, July 14 - Welcome Reception Wednesday, July 15 - Continental Breakfast Wednesday, July 15 – Networking Luncheon Thursday, July 16 - Continental Breakfast Thursday, July 16 – Networking Luncheon Registrant Free Free Free Free Free Free Free Guest $25 ea. $35 ea. $25 ea. $25 ea. $35 ea. $25 ea. $35 ea. WORKSHOPS Student Workshop: FREE for students registered for the full conference. You must pre-register to attend. Mon, July 13 8:00AM-5:00PM Business Plan Competition: FREE You must be preregistered and complete the plan package by June 12, 2015. Wed, July 15 10:00AM-5:00PM Career Workshop: FREE You must register on-site by noon Wed July 15 to attend. Wed, July 15 6:00pm-10:00PM All registrations must be prepaid by check or credit card in order to be processed. Please submit a separate registration form for each registrant. Return completed form to: ACS, Attn: GC&E2014, PO Box 3337, Columbus, OH 43210-3337 or FAX 614- 447-3671. For questions, call 800-333-9511 or 614-447-3776. HOUSING RESERVATIONS: The ACS Green Chemistry Institute® has negotiated a special rate of $199 (plus taxes) for conference attendees at the Bethesda North Marriott Hotel & Conference Center, 5701 Marinelli Road, Rockville, MD 20852. To make a reservation at this rate, call 877-212-5752 or 301-822-9200 and mention the Green Chemistry & Engineering Conference or visit https://resweb.passkey.com/go/21ffc122 STUDENT HOUSING: Visit the student page at www.gcande.org/students for information on local housing options. CANCELLATION/REFUND POLICY: Registration cancellation requests must be received in writing on or before July 3, 2015 to qualify for a refund. A $50 administrative fee will be deducted for all approved cancellations received on or before June 3, 2014. Approved refunds will be processed after the conference. Refunds will not be approved for downgrading from one registration category to another. No refunds will be given after July 3, 2015. Email refund requests to gceconferences@acs.org If you require special services or assistance please e-mail gceconferences@acs.org A complete list of registration policies can be found at http://www.gcande.org/registration TOTAL FEES: Registration $_____ Ticketed Events $_____ Paid by: American Express MasterCard Visa Discover Check (payable to American Chemical Society) EXP. DATE Cardholder Name (please print): _____________________________________________________ TOTAL AMOUNT ENCLOSED $_____ Signature: ________________________________________________________________________