Conference Registration

Conference Registration

Fall Meeting 2010	Michigan Branch
April 9-10, 2010	American Society for Microbiology
Western Michigan University	www.mi-asm.org

All fields are required. Please fill everything out as accurately as possible.

Registrant Information

First:

Last:

Email:

Rank:

Address:

Address (2):

Address (3):

City:

State:

Zip/Postal Code:

Phone:

Required (10 numbers, no spaces)

School/Company:

National ASM Member?

National ASM Member #

Registration Fees

Membership Dues:
	Select all that apply
		I have already paid my membership dues through National (enter $0 above)
		I already paid the annual dues in Spring (enter $0 above) Fall Only! If you have not paid in Spring, enter amount above.
		I am the lead student presenter of a poster or presentation (enter $0 above)

Meeting Fees:*
	Select all that apply
		I need a vegetarian meal

Total Amount Due:

Payment is due at the meeting. Please make your check payable to MI-ASM.


Volunteer
		Please contact me about becoming a corporate sponsor.
		Please contact me about serving on the MI-ASM Board.
		I would like information about serving as a volunteer for MI Branch of ASM.

Special Needs/Comments?

*Postdoctoral fellows are considered to be students. Back
*An Emeritus Member is an individual who has been a member in good standing for no less than 10 consecutive years immediately preceding his/her retirement. Emeritus status must be renewed annually at no charge. Back