Registration Form

4th Annual Nassau Inn Meeting Program Formulation & Process Development for Oral  Dosage Form      April 22-27, 2007 -  Nassau Inn, Princeton, New Jersey, USA

PTI-2007-03   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       Fax   AAPS Meeting  Colleagues Other   Please select the modular sessions of the program  after reviewing the registration fee options.   Day Modular Session Selection Apr 24 Module 1: Crystal Form of API     Module 2:  Preformulation Apr 25 Module 3:  Formulation & Process Dev.   Module 4:  Milling, Mixing and Flow Apr 26 Module 5:  Granulation         Module 6:  Compaction Apr 27 Module 7:  Film Coating    Module 8:  Technology Transfer Apr 28 Module 9: Stability   Please Select/Calculate the registration fee as it applies to you!       Minimum 5 Modules  Each Additional Module  All 9  Modules Per Person  $ 2,000.00  $ 350.00  $ 2,750.00 Per person (If 3 or more register per company  at the same time)  $ 1,800.00  $ 315.00  $ 2,475.00 Registration Fee includes the presentation handouts (in color), a CD containing the presentations in pdf format, as well as continental breakfast, lunch and refreshment breaks during the program. Cancellation Fee:  The amount of registration fee that will be withheld upon cancellation will be as follows: 10% before January 22, 2007. 25% after January 22, 2007 and before February 22, 2007. There will be no refund after February 22, 2007. Substitution of individual participants will be permitted at any time.   REGISTER BEFORE JANUARY 15, 2007 AND GET A FREE PERSONAL HANDHELD PC (PDA). PLEASE NOTE THAT ONLY ONE PDA IS GIVEN FOR THE WHOLE GROUP REGISTRATIONS WHO ARE ENTITLED TO ADDITIONAL 10% GROUP DISCOUNT. Please Select The Payment Method   PAYMENT METHODS:  Registration Fee: Check Money Order (USA only) International Money Order (Worldwide) Purchase Order  (USA Only) - Must be received by March 31, 2006. Electronic Funds Transfer Credit Card If Credit Card Payment Method is selected: Card Type:      Select Credit Card Type American Express Visa Master Card Discover Card Number: Expiration Date (MM-YY)  00 01 02 03 04 05 06 07 08 09 10 11 12- 00 04 05 06 07 08 09 10 Name on card:  Credit Card Billing Address: Street-1   Street-2   City            State Zip Code Country Please note that for security purposes, we kindly ask you to provide us the following the Credit Card ID (CID) either via email (training@pt-int.com or phone (1-908-864-0555). NOTE: CID is generally found on the back of your card in the signature area. Please note that for Visa or Master Card holders, the CID is the last three digits of the number given at the back of the card, and, for American Express card holder, it is a 4 digit number given at the front of the card. 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. After receiving a confirmation email from PTI, Inc., for your application, you may then make your registration payment according to the method you have selected. Please note that the registration fee includes the presentation materials, continental breakfast, lunch and refreshment breaks. Thank you in advance for your interest in our training program. PTI Inc.

For Further Information, Please Contact:

E-MAIL PHONE FAX Training Program Training@pt-int.com 1-908-864-0555 1-908-864-0556 Dr. Metin Çelik Metin.Celik@pt-int.com 1-908-864-0555 1-908-864-0556 PTI, Inc. Mailing Address Regular Mail  PO Box 186, Belle Mead, NJ 08502, USA Overnight Mail  22 Durham Road, Skillman, NJ 08558, USA Close