Congress Co-Chairs

Paul Lieberman, Ph.D.
The Wistar Institute

Erle Robertson, Ph.D.
Perelman School of Medicine at the University of Pennsylvania

Yan Yuan, Ph.D.
University of Pennsylvania School of Dental Medicine

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Conference Registration

Please complete the fields below to register for the International Congress on Oncogenic Herpesviruses and Associated Diseases 2012 (ICOHAD 2012).

For questions about registration, please contact Jennifer McGuire at ICOHAD@mail.med.upenn.edu, or call 215.349.8386.

Registrant Information

*Required fields

*First Name:

*Last Name:

Degree(s):

*Title:

Department:

*Institution:

Parent Institution:

*Address:

Address:

*City:

*State/Province:

*ZIP/Postal Code:

*Country:

*Email Address:

*Telephone #:

Mobile #:

Fax #:

If registration is being completed by someone other than the registrant, please enter contact's e-mail address below.

Alternate Contact Email Address:

Payment Information

REGISTRATION COST: $750 USD
Conference fee includes most meals, including the Closing Banquet; it does NOT include accommodations.

Please select appropriate category:

Government/Industry
Academic
Postdoctoral Students/Fellows
Graduate Students

Trolley tour of Philadelphia (Friday, August 3, 2012)

Yes ($20 additional fee will be added to your registration total cost)
No

Closing Banquet: Saturday, August 4, 2012 at the National Constitution Center
Please select your entrée:

Meat
Fish
Vegetarian

I will bring a guest to the Closing Banquet on August 4, 2012 (Cost $150)

Payment Method

You may pay via credit card or wire transfer. Credit cards must be paid at the time of registration. You will be prompted to continue the payment portal after your initial registration is submitted.

Credit Card

You will be prompted to continue the payment portal after your initial registration is submitted.

Wire transfer

To make payment to the University of Pennsylvania via wire transfer, please follow wire instructions below to ensure prompt crediting of funds. Wire transfer payments must be remitted within 30 days of registration, and no later than June 15, 2012.

Wells Fargo Bank N.A.
420 Montgomery Street
San Francisco, CA 94101
ABA Routing #: 121-000-248 (domestic wires)
SWIFT CODE: WFBIUS6S (for international wires only)
CHIPS: 0407
Account Name: The Trustees of the University of Pennsylvania
Account# 2000018692644
Reference: 4607 215-662-3412

PAYMENT POLICY
Payments made by credit card are due at the time of registration; payments by wire transfer are due within 30 days of registration. All registrations are considered final as soon as information is submitted for processing. Regardless of payment method, refer to the ICOHAD 2012 cancellation policy below for refunds and cancellation fees.

CANCELLATION POLICY
The ICOHAD 2012 cancellation policy is as follows: 100% of registration fee, less a $50 processing fee, will be refunded for cancellation by May 31, 2012; 50% of registration fee, less a $50 processing fee, for cancellation from June 1 through June 15, 2012; no refunds for cancellation on or after June 16, 2012. All cancellations must be submitted in writing, via e-mail or regular mail. All refunds will be processed after August 15, 2012.

ICOHAD 2012 reserves the right to cancel this activity because of unforeseen circumstances. In the event of such cancellation, the full paid registration fee will be returned to each registrant.

*I have read and agree to the terms of the cancellation policy.

Please enter the letters and numbers you see below.