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SARNOFF CARDIOVASCULAR RESEARCH FOUNDATION
31ST ANNUAL SCIENTIFIC MEETING

April 28-30, 2011
Gaylord National Harbor Hotel, National Harbor, Maryland

ONLINE REGISTRATION FORM

REGISTRATION DEADLINE: FRIDAY, MARCH 25, 2011

REGISTRANT CONTACT INFORMATION

FIRST NAME:   LAST NAME:

Name you wish to appear on nametag:

DEGREE(S):

CURRENT TITLE:
INSTITUTIONAL AFFLIATION/EMPLOYER:

MAILING ADDRESS:

EMAIL ADDRESS:

PHONE:

SPOUSE/GUEST:

If applicable, please print name of Guest:

Additional costs: Hotel room - $100 per room/per night
Dinner guest fees - $75/per night, if attending

Guest fees may be paid online via Paypal or a check made out to the "Sarnoff Cardiovascular Research Foundation" should be sent to the Sarnoff Foundation Office, 731 Walker Road, Suite G2, Great Falls, VA 22066 for the additional guest fees.

Guest Cancellation Policy - You will be responsible for all guest fee(s) if you do not cancel the reservations (hotel and/or event(s)) with the Foundation by April 1.

HOTEL INFORMATION (GAYLORD NATIONAL HOTEL)

HOTEL ROOM NEEDED?
 
CHECK-IN DATE:
APPROXIMATE TIME:
 
CHECK-OUT DATE:
APPROXIMATE TIME:
 
ROOMMATE REQUEST:
GUEST HOTEL ROOM NEEDED?
 
GUEST CHECK-IN DATE:
APPROXIMATE TIME:
 
GUEST CHECK-OUT DATE:
APPROXIMATE TIME:
 
GUEST ROOMMATE REQUEST:

Please note: If you register for the Annual Scientific Meeting and are unable to attend, you must notify the Foundation by March 25th to cancel your hotel reservation. If you notify the Foundation after this date, you will need to pay a $50/night hotel reservation penalty.

MEETING/EVENT REGISTRATION

Thursday, April 28
Round Table: Negotiation Skills/Leading a Team
2:30-4:30 pm
Round Table: Grant Writing
4:30-5:30 pm
Round Table: Careers in Academia, Private Practice, Government and Industry
4:30-5:30 pm
Dinner Reception
6:00-9:00 pm
Include Guest?
Friday, April 29
Breakfast
7:30-8:30 am
Include Guest?
Luncheon
12:20-1:30 pm
Include Guest?
Awards Dinner
6:30-9:00 pm
Include Guest?
Saturday, April 30
Breakfast
7:30-8:30 am
Include Guest?
Luncheon
12:00-1:00 pm
Include Guest?

PERMISSION TO PUBLISH

From time to time, the Sarnoff Foundation may reproduce photographs, or other media forms, of the event attendees for its official publications. Additionally, there may be occasions where the Foundation wishes to utilize certain information about the attendees including name, address, school and laboratory affiliations, and other appropriate information in the public domain or provided to the Foundation. You agree to allow the Foundation to publish, in any form, and in its discretion, the information contained in such documents or similar documents, as well as any pictures, videos or similar reproductions and recordings made in connection with the Foundation's sponsored events and programs.

Yes, I give permission       No, I decline permission

Additional Comments/Requests:

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Sarnoff Cardiovascular Research Foundation
731 G-2 Walker Road, Great Falls, VA 22066
P: (888) 4-SARNOFF or (703) 759-7600   -   F: (703) 759-7838   -   Email: dboyd@SarnoffFoundation.org