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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.
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