Registration Form:

9th Annual National American Synesthesia Association, Inc.
Conference at University of California San Diego
October 14–16, 2011

Registration for the conference is necessary for all who wish to attend.

All selected presenters who are US residents must be members of the American Synesthesia Association.

Registration Fees

Early Registration Fees Received before August 5, 2011 :

$100.00 (ASA Members)
$100.00 (All UCSD University Faculty)
$125.00 (Non Members)
$ 50.00 (Students with current valid ID)


Registration Fees Received between August 6, 2011 and September 9, 2011

$130.00 (ASA Members)
$130.00 (All UCSD University Faculty)
$150.00 (Non Members)
$ 50.00 (Students with current valid ID)

Late Registration Fees Received after September 10, 2011 or At the Door

$150.00 (ASA Members)
$150.00 (All UCSD University Faculty)
$165.00 (Non Members)
$ 50.00 (Students with current valid ID)




Method of payment:

If paying by check or money order please complete the following information:


First Name: ______________________________________________________________

Last Name: _______________________________________________________________

Street Address: __________________________________________________________

City, State, Postal Code: _________________________________________________

Country: _________________________________________________________________

Telephone Number: ________________________________________________________

Fax Number: ______________________________________________________________

E-mail Address: __________________________________________________________

Website: _________________________________________________________________


Please print out a copy of this registration form, fill it out, and send it with your check or money order via regular mail to:

American Synesthesia Association, Inc.
515 Greenwich Street, Suite 304
New York, NY 10013

Checks or money orders must be drawn on a U.S. Bank, made payable to the American Synesthesia Association, Inc.

Confirmation of receipt will be by email only.

The ASA cannot be held responsible for reservations that are not received in a timely manner.