Registration for QMDNS Workshop

To register for the Workshop please complete the form below, and then click the SUBMIT APPLICATION button. Items in red are required. Following submission, a confirmation of your application/registration will be displayed. (Print a copy for your records.)

REGISTRATION FEE:

Early Bird: $75.00 if you register by April 15, 2008

$100.00 after April 15, 2008

NISS accepts check, Visa, or MasterCard.

For Credit Card Payments:

Fill out the Payment Form (PDF file)
Fax it to (919) 685-9310

For Check Payments:

Fill out the Payment Form (PDF file)
Mail the form and check (payable to NISS) to:

In order to guarantee proper credit to your registration, NISS must receive payment by Wednesday, May 14, 2008.

Participant Information

First Name Family Name

Organization

Address

City State Zip (or Postal) Code

Country Required if not US

Telephone

FAX

E-mail

Registration Fee

$75.00 before April 15 $100.00 after April 15

Hotel Requirements

None I will make my own reservation from the NISS block at the Marriott Durham. (919-768-6000)

NISS Affiliates and NISS/SAMSI University Affiliates Only

Check this box if you are from a NISS Affiliate and plan to request reimbursement from your NISS/SAMSI Reimbursement Account.

Special Requests

If you have special requests (such as dietary restrictions), please enter them below. Other questions should be sent by E-mail to qmdns2008@niss.org.