AMS Summer Policy Colloquium Registration

First Name*

Nickname for badge (if applicable)

Last Name*

Email*

Company or Agency

Address

City

State

Zip (xxxxx-xxxx)

Phone (xxx-xxx-xxxx)

Fax (xxx-xxx-xxxx)

Cell (xxx-xxx-xxxx)

Reading Materials will be sent out in late April 2012 shipped directly from the supplier. Please provide the address where the materials should be sent. FEDEX does not deliver to P O Boxes.
Hardcopy
Digital

Address for Book Shipment (if different)

AMS has secured a room block at the Washington Marriott at Metro Center. Please indicate your room preference below; paying participants will be required by the hotel to provide the first night's deposit to secure the room. (An invoice will be sent to paying participants for the $5000 registration fee which includes all sessions, workshops, tours/briefings, and materials) Room prices have yet to be determined.

King Non-Smoking
King Smoking
Double Non-Smoking
Double Smoking
Handicapped Accessible Room

Travel Dates

Arrival Date (mm/dd/yy)


Departure Date (mm/dd/yy)

Diet or Special Needs

Are you applying for NSF Funding?
Deadline Passed for Funding

Select: Deadline passed

Please enter a contact person (if different) for payment.

Name (first and last)

Title

Phone (xxx-xxx-xxxx)

Fax (xxx-xxx-xxxx)

Email

Comments or Questions