Metabolism and Cancer
September 13-16, 2009
San Diego Marriott La Jolla
La Jolla, CA
Registration Form Early Registration Deadline: July 13, 2009
Name and Address Information Registration Rates Please circle the appropriate rate(s):
K AACR Membership # ______________ K Nonmember Early Advance After
Dr. Registration Registration August 31
Mr. Until July 14- and Onsite
Ms. July 13 August 31 Registration
Last Name AACR Members
Active (REGA) $535 $565 $595
First Name/Middle Initial Affiliate (REGF) $535 $565 $595
Degree: K Ph.D. K M.D. K M.D./Ph.D. K Pharm.D. K D.Sc. Associate (REGS) $325 $355 $385
K Other (specify) __________________________________________ Emeritus (REGE) $325 $355 $385
Scientific Research Focus: K Basic K Translational
K Clinical K Epidemiological K Behavioral Science
Academic, government, and
Race or Ethnic Background (check only one):
K Caucasian K African American/Black K Hispanic K Asian
not-for-profit institutions (NNP) $695 $720 $745
K Native American K Alaskan Native K Native Pacific Islander K Other Industry (NIN) $895 $935 $975
Gender: K Male K Female Spouse/Guest (no admittance to lecture sessions)
Information concerning gender and ethnic background is solicited to enable the Adult (SPO) $150 $150 $150
association to ensure that its programs are appropriately serving all members of the Children (4-12 years old) (CHD) $ 50 $ 50 $ 50
cancer research community.
Total Enclosed or Charged US$ ______________________________________
Refund Policy: Requests for refunds must be made in writing. There will be
a $75 processing fee for cancellations before August 21, 2009. After
August 21, 2009, no refunds can be given.
Method of Payment
Street/Building or Post Office Box K Check or money order enclosed, payable to American Association for Cancer Research,
drawn on a U.S. bank.
City/State or Province K VISA K MasterCard K American Express
Zip or Postal Code/Country Card# Expiration Date
Telephone Fax Print Name of Cardholder
Signature of Cardholder
Spouse/Guest’s name, if registering
Registration fees are payable in U.S. dollars only. Personal checks are acceptable if payable
K New address. Please change my AACR mailing information. through a U.S. bank.
Have you submitted or do you plan to submit an abstract by the July 13, 2009 deadline?
K Yes K No
Return to: Metabolism and Cancer Conference
American Association for Cancer Research
Please check any awards that you intend to apply for by the July 13, 2009 deadline.
615 Chestnut Street, 17th Floor
Award application instructions are available on the AACR website.
K Minority-Serving Institution Faculty Scholar Award
Philadelphia, PA 19106-4404
K Minority Scholar Award Phone (215) 440-9300 • Fax (215) 351-9165
K Scholar-in-Training Award (abstract submission required)
K If you will require special accommodations, please specify:
Register online at www.aacr.org