9th Meeting, Australasian Gene and Cell Therapy Society (AGCTS)
University College, University of Melbourne, Parkville
29 April – 1 May 2015
Registration Details
Title
Organisation
Address
Name
Post code
Contact Phone
Fax
Email
Date
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Registration Options
Full conference registration includes: *catering (3 days), conference dinner, conference satchel & abstract book, JGM abstract
publication.
Day registration includes: *catering on nominated days, conference satchel & abstract book and JGM abstract publication.
*Catering includes: welcome drinks & canapés Wednesday evening 29 April, lunch, morning & afternoon refreshments.
Early Bird Registration - Register by 6th April 2015
Full Conference
Member
Non-member
Student member
Non-member student
Day Registration
$200
$280
$140
$180
$490
$690
$340
$430
Wed
Wed
Wed
Wed
Nominate Day
Thu
Fri
Thu
Fri
Thu
Fri
Thu
Fri
Wed
Wed
Wed
Wed
Nominate Day
Thu
Fri
Thu
Fri
Thu
Fri
Thu
Fri
Regular Registration - After 6th April 2015
Full Conference
Day Registration
Member
$590
$240
Non-member
$790
$320
Student member
$390
$160
Non-member student
$480
$200
Invited Speaker (Full conference registration waived)
Platinum, Gold, Silver Sponsor (Full conference registration waived)
Conference Dinner: Thursday 30 April 2015
$120 per day registrant or guest
No. of tickets:
Special Dietary Requirements:
Guest Name:
AGCTS Membership application / renewal
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Biennial subscription / Renewal of full member
Biennial subscription / Renewal of student member
Optional electronic subscription to Journal of Gene Medicine (JGM)
Membership details to appear on AGCTS website or abstract book?
$180
$100
$136
Yes
No
Total
Abstract submission (Deadline 6th April 2015)
Maximum 250 words (refer to abstract guidelines) – Abstracts to Dr Samantha Ginn
 Eligible for a Student Prize
 Eligible for the Panos Ioannou Young Investigator Award
Student’s Supervisor Name
Email: sginn@cmri.org.au
Signature
Payment details ($AUD only drawn on an Australian bank)
I enclose
$
Credit card details:
Name on Card
Payment as a cheque
Visa
or
or I authorise the AGCTS to debit my credit card
Mastercard
Signature
Card Number
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Expiry date _ _ | _ _
Credit card payments
Please email completed form to Prof. Ann Simpson (Treasurer AGCTS) Email: Ann.Simpson@uts.edu.au
Make cheques payable to Australasian Gene and Cell Therapy Society
Please post to Prof. Ann Simpson,
School of Medical & Molecular Biosciences, Faculty of Science, University of Technology Sydney
PO Box 123 Broadway NSW 2007
Please check box if you require a receipt