Pre-registration form (PDF format) - Paleopathology Association

Paleopathology Association 39th Annual Meeting (North America)April 10-11, 2012, Portland, OregonPre-Registration FormPre-registration deadline is February 27, 2012 (postmarked). After this date the registration fees increase(see below). Non-United States members can pay on site but must send in the pre-registration form by thedeadline to qualify for the pre-registration rate.THE ASSOCIATION DINNER IS INCLUDED IN THE REGISTRATION FEE.At least one author of a multi-authored presentation must pre-register in order for the abstract to be acceptedfor presentation. That author must be a current member of PPA.NameAddressAffiliation as you wish it to appearon your badgeEmail address (please print veryclearly)I would like to attend the following events: (participation is on a “first come/first served” basis)Workshop - A hands-on introduction to the Smithsonian Institution's OsteowareYes ___ No ____ skeletal documentation software. Dr. Christopher Dudar and the Osteoware Team.Tuesday, April 10, 2012 9:00am -12:00pmYes ___ No ____Yes ___ No ____Student member ( ___ )Regular member ( ___ )STUDENTS ONLY--- Student Action Committee Gathering (no charge!),Tuesday, April 10, 2012 ~5:15pm.“Let’s Do Lunch”-- A great opportunity for student and senior members of the PPA to meet overlunch—with Regular members paying for lunch. 12pm Wednesday April 11thRegular PPA members agree to “treat” at least one student to lunch. Vegetarian and non-vegetarianmenu items will be available. Students will be registered for this event on a first-come/first-servebasis, as space is limited.Please tick the following as appropriate:_______I have submitted an abstract for presentation at the meeting_______I have submitted a paper or a poster for the Cockburn Student Award.(The student presenting the paper/ poster must pre-register for the meeting. Please check the PPA website(www.paleopathology.org) for criteria and eligibility for this award.)Registration TypeStudent pre-registration(postmarked by February 27, 2012)Fee$75.00Student late registration $85.00Please place a check markin the appropriate boxRegular member pre-registration $100.00(postmarked by February 27, 2012)Regular member late registration $120.00Non-member pre- registration$150.00(postmarked by February 27, 2012)Non-member late registration $175.00Wednesday attendance (April 11)ONLY$50.00

BOTH PAGES OF THIS FORM MUST BE SUBMITTED FOR REGISTRATIONTO BE COMPLETEBOTH PAGES OF THIS FORM MUST BE SUBMITTED FOR REGISTRATION TOBE COMPLETEPaleopathology Association39th Annual Meeting (North America)April 10-11, 2012, Portland, OregonPre-Registration Form: PAYMENT INFORMATIONPre-registration deadline is February 27, 2012 (postmarked). After this date the registration fees increase. Non-United Statesmembers can pay on site but must send in the pre-registration form by the deadline to qualify for the pre-registration rate.Name of person pre-registering _______________________________________Pre-registration PaymentPayment options:o Checks (US dollars only) payable to The Paleopathology Association.o Cash (for Non-US members ONLY—cash can be paid on-site)o Credit card (VISA or MasterCard). We cannot accept wire transfers.______________________________________________________________________________________________Fees:Total preregistration fee$______________TOTAL PAYMENT $_____________________________________________________________________________________________________________________________I am enclosing a check or money order in U.S. dollars_____ I am traveling internationally and will pay with cash on-site_____I am paying by credit card: VISA_____ MasterCard_____FOR CREDIT CARD PAYMENTS:Name as it appears on credit card _________________________________________Credit card number _________________________________________ Expiration Date ___________Total Amount to be charged to credit card $___________Please return BOTH PAGES OF THIS form to:Marie Danforth ATTN: PPADept of Anthropology and SociologyUniversity of Southern Mississippi118 College Dr #5074Hattiesburg, MS 39406treasurer@paleopathology.org