Registration Form 8th Annual Nassau Inn Meeting Program Formulation & Process Development for Oral Dosage Form August 27 -31, 2012 - Nassau Inn, Princeton, New Jersey, USA PTI-2012-01 Personal Information Mr. Ms Mrs. Dr. Prof. Full Name Job Title Organization Department Address Street-1 Street-2 City State Zip Code Country E-Mail Phone Fax: How did you hear about the program? Mail Email AAPS Meeting Colleagues (Name) Other Please Select/Calculate the registration fee as it applies to you! REGISTRATION FEE & IPAD/NETBOOK OPTIONS FEE Handout Option Per Person $ 3,150.00 Free IPAD Per person (If 3 or more register per company at the same time) $ 2,835.00 Free Netbook Registration Fee includes the course materials as well as Sunday reception, A Night-Out-Dinner, and continental breakfast, morning refreshment breaks, lunches and afternoon refreshment breaks throughout the program. Cancellation Policy: The amount of registration fee that will be withheld upon cancellation will be as follows: 10% on/before June 1 10, 2012, 25% after June 1, 2012 and on/before June 30, 2012. There will be no refund after June 30, 2012. Substitution of individual participants will be permitted at any time. Please Select The Payment Method PAYMENT METHODS: Registration Fee: Promotion Code (Full Registration Only): Check Money Order (USA only) International Money Order (Worldwide) Purchase Order (USA Only) . Electronic Funds Transfer Credit Card If Credit Card Payment Method is selected: Card Type: (Select your card type) American Express Visa MasterCard Discover Network Name (as appeared) on card: Card Number: Please enter your credit card # without spaces or dashes (i.e. 00000000000) Card ID: Where is my Card ID? Expiration Date (MM-YY): 01 02 03 04 05 06 07 08 09 10 11 12 / 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Credit Card Billing Address Address should match that of the credit card Street-1: Street-2: City: State: Zip Code: Country: There will be three or more people attending this program from my company. I have dietary restrictions : Checks, Money Orders, and International Money Orders should be made payable to PTI, Inc. In case of Electronic Fund Transfer, the confirmation of the details of the transaction must be sent to PTI Inc. by fax or e-mail. The details of the bank account information for Electronic Fund Transfer will be provided after receiving the registration form. On site registration will be allowed only if there is any available space. IMPORTANT NOTE Please DO NOT forget to review the completed registration form carefully BEFORE you click on the SUBMIT button. Please PRINTOUT the completed form using your browser's file/print option for your records before clicking on the SUBMIT button. You will be receiving either an instant auto response from PTI or an e-mail response from one of the course directors within 48 hours to confirm that your registration form has been received. If you do not receive this response within 48 hours, please contact PTI Inc. (training@pt-int.com) as soon as possible or fax a copy of the printout of the form.. Thank you in advance for your interest in our training program. PTI Inc. For Further Information, Please
PTI-2012-01 Personal Information Mr. Ms Mrs. Dr. Prof. Full Name Job Title Organization Department Address Street-1 Street-2 City State Zip Code Country E-Mail Phone Fax: How did you hear about the program? Mail Email AAPS Meeting Colleagues (Name) Other
PTI-2012-01
Personal Information
Mr. Ms Mrs. Dr. Prof.
Full Name
Job Title
Organization
Department
Address
Street-1 Street-2 City State Zip Code Country
E-Mail
Phone
How did you hear about the program?
Mail Email AAPS Meeting Colleagues (Name) Other
Please Select/Calculate the registration fee as it applies to you!
Registration Fee includes the course materials as well as Sunday reception, A Night-Out-Dinner, and continental breakfast, morning refreshment breaks, lunches and afternoon refreshment breaks throughout the program. Cancellation Policy: The amount of registration fee that will be withheld upon cancellation will be as follows: 10% on/before June 1 10, 2012, 25% after June 1, 2012 and on/before June 30, 2012. There will be no refund after June 30, 2012. Substitution of individual participants will be permitted at any time.
Registration Fee includes the course materials as well as Sunday reception, A Night-Out-Dinner, and continental breakfast, morning refreshment breaks, lunches and afternoon refreshment breaks throughout the program.
Cancellation Policy: The amount of registration fee that will be withheld upon cancellation will be as follows: 10% on/before June 1 10, 2012, 25% after June 1, 2012 and on/before June 30, 2012. There will be no refund after June 30, 2012. Substitution of individual participants will be permitted at any time.
Please Select The Payment Method
PAYMENT METHODS:
Check Money Order (USA only) International Money Order (Worldwide) Purchase Order (USA Only) . Electronic Funds Transfer Credit Card
Address should match that of the credit card
There will be three or more people attending this program from my company.
Checks, Money Orders, and International Money Orders should be made payable to PTI, Inc.
In case of Electronic Fund Transfer, the confirmation of the details of the transaction must be sent to PTI Inc. by fax or e-mail. The details of the bank account information for Electronic Fund Transfer will be provided after receiving the registration form.
On site registration will be allowed only if there is any available space.
IMPORTANT NOTE
Please DO NOT forget to review the completed registration form carefully BEFORE you click on the SUBMIT button.
Please PRINTOUT the completed form using your browser's file/print option for your records before clicking on the SUBMIT button.
You will be receiving either an instant auto response from PTI or an e-mail response from one of the course directors within 48 hours to confirm that your registration form has been received. If you do not receive this response within 48 hours, please contact PTI Inc. (training@pt-int.com) as soon as possible or fax a copy of the printout of the form..
Thank you in advance for your interest in our training program. PTI Inc.
For Further Information, Please