Call for Abstracts CLINICAL TRIAL DISCLOSURE “Emeralds of Experience” presentations learning the landscape and DUE BY SEPTEMBER 17, 2007 reading the roadmap November 13-14, 2007 Hyatt Regency Bonaventure Conference Center and Spa, Weston, FL, USA PROGRAM CHAIRS This conference will provide practical, pharmaceutical and biotech company-based BARBARA GODLEW, RN experience/advice and a hands-on conference venue for complying with worldwide Associate Director, Publication Coordination regulations for public disclosure of clinical trial information. Individuals delivering and Transparency Compliance Exploratory Development Communications, Novartis this conference work inside the industry ensuring company compliance with laws Pharmaceuticals Corporation and regulations governing the public disclosure of clinical trial information. PAMELA ROSE, RN, BSN, ASQ-CMQOE Knowledge gained from industry-driven experience cannot be overstated. Director, Clinical Trial Information Registries, TAP Pharmaceutical Products Inc. PROGRAM COMMITTEE This Event is Co-located with 4 other DIA Conferences TRACY BECK, PhD for Added Networking Opportunities! Global Medical Business Office Consultant; CTR Results Gatekeeper, Eli Lilly and Company Publication Writing and Building Partnerships 5 cated DIA Outsourcing Summit Co-lo ts MARGARET M. COBB, MD Global Leader of J & J Clinical Registry, PMI Pharmaceutical SIG/DIA PM SIAC Joint Conference: The Future of Johnson & Johnson Pharmaceutical Research Even Pharmaceutical Project Management – Is a Paradigm Shift Needed? & Development, LLC Winning Strategies for Achieving a Quality EDC Clinical Trial Process: MARY KUSKIN, RPh Sponsor/CRO, Investigator, IRB Approver and IT/IS Director, Regulatory Affairs Pharmalink Consulting Inc. GERARD LYNCH Global Manager, AstraZeneca Clinical Trials Website, AstraZeneca WHO SHOULD ATTEND JOHN C. McKENNEY, Sr. Those who will benefit from attending this program include: President & CEO, SEC Associates Inc. ROBERT PAARLBERG, MS Clinical trial sponsors Pharmaceutical industry and academic Director, Global Regulatory Policy and Intelligence, Independent investigators clinical researchers UCB, Inc. Biotechnology researchers Clinical research and development departments Investigator site personnel Investigational review boards/ethics MICHAEL RUBISON committees Senior Director, Global Medical Research Regulatory affairs personnel and Registration, Abbott Laboratories Clinical quality assurance professionals Medical communications groups MAUREEN STRANGE Associate Medical Business Operations Consultant; CTR Initiated Gatekeeper, Eli Lilly and Company PATRICIA TEDEN, MBA See page 5 for Suggested Abstract Topics and Independent Consultant Abstract Submission Guidelines MILEN VRABEVSKI, MD Medical Director/CEO, Comac Medical Ltd. THIS PROGRAM WAS DEVELOPED BY THE GOOD CLINICAL PRACTICES AND QUALITY ASSURANCE CLINICAL TRIAL DISCLOSURE WORKING G R O U P A N D T H E C L I N I C A L R E S E A R C H , R E G U L AT O RY A F FA I R S , A N D For further information, contact MEDICAL WRITING SPECIAL INTEREST AREA COMMUNITIES Ellen Diegel, Program Manager Phone +1.215.442.6158 / Fax +1.215.442.6199 COMPLETE SCHEDULE OF EVENTS! VISIT WWW.DIAHOME.ORG FOR A % Ellen.Diegel@diahome.org DIA, 800 Enterprise Road, Suite 200, Horsham, PA 19044, USA tel: +1-215-442-6100 fax: +1-215-442-6199 email: email@example.com Continuing Education The Drug Information Association (DIA) has been reviewed and approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1620 I Street, NW, Suite 615, Washington, DC 20006. The DIA has awarded up to 1.1 continuing education units (CEUs) to participants who successfully complete this program. To receive a statement of credit, please visit www.diahome.org. Detailed instructions on how to complete your credit request and download your certifi- cate will be provided onsite. Disclosure Policy: It is Drug Information Association policy that all faculty participating in continuing education activities must disclose to the program audience (1) any real or apparent conflict(s) of interest related to the content of their presentation and (2) discussions of unlabeled or unapproved uses of drugs or medical devices. Faculty disclosure will be included in the course materials. Learning Objectives: At the conclusion of this conference, participants should be able to: Name the major stakeholders influencing policymaking regarding the disclo- Discuss the required, proposed and voluntary requirements for clinical sure of clinical trial information trial registration in the United States and other countries described in the Apply for a ClinicalTrials.gov protocol registration account workshop Describe how, where, and when to publicly register a clinical trial and to post Describe the clinical trial lifecycle and the relevance to clinical trial clinical trial results disclosure Plan a clinical trial disclosure process appropriate for their company use Explain the relationship between registration and the trial publication plan Differentiate relevant differences between major regulations, recommenda- Describe processes for ensuring the company is prepared for audit tions, and guidelines worldwide Special 5-in-1 Plenary Session ! MONDAY • NOVEMBER 12 with the role of the market in health care delivery, contractors as customers, and the very large amounts spent on R&D. 4:00-6:00 PM REGISTRATION Outsourced costs such as CRO contracts and clinical grants represent a very large portion of all drug development spending. Pharmaceutical professionals involved in outsourced activities TUESDAY • NOVEMBER 13 need to understand the role that business plays, and does not 7:30-8:15 AM REGISTRATION AND play, in the entire process, as well as how the major actors CONTINENTAL BREAKFAST involved need to interact with one another. Professor Harold E. Glass has more than twenty-five years’ international 8:15-8:30 AM WELCOME AND OPENING REMARKS experience in business and in the pharmaceutical industry. He is professor of health policy at the University of the Sciences in Philadelphia (USP). USP 8:30-9:15 AM Plenary Session has a long legacy in the pharmaceutical industry dating back to University’s Join your colleagues from all 5 conferences during this special founding in 1821, counting among its distinguished graduates such indus- plenary session featuring keynote speaker Harold Glass, PhD, try giants as Lilly, Wyeth, Rorer, Smith, Kline, Burroughs, Wellcome, followed by a spirited Q&A session. Warner, Lambert, McNeil and many others. He is also senior research fel- low at the Centre for Evidence Based Policy at Queen Mary, University of London. Added Feature! Shared refreshment breaks, luncheons, and networking reception Dr. Glass holds a MSc (Econ.) from the London School of Economics and a PhD from the University of North Carolina. He has served on the faculties allow for extensive multidisciplinary networking opportunities of the University of North Carolina and University of Zurich, and has pub- among attendees lished widely in the areas of business strategy and drug development. Keynote Address Professor Glass is the founder of DataEdge, LLC, which he sold in 2001 to DRUG DEVELOPMENT AS A BUSINESS: THE ROLE OF IMS Health. DataEdge was a company focusing on drug development and pharmaceutical marketing. OUTSOURCING Harold Glass, PhD, Professor, Health Policy, University of the Sciences in Philadelphia; President, TTC, LLC 9:15-9:45 AM Q&A Session with Keynote Speaker Pharmaceutical drug development is part of a distinctive global business, distinguished by: the interaction of health care equity 9:45-10:15 AM REFRESHMENT BREAK Program Agenda for Clinical Trial Disclosure 10:15-10:30 AM WELCOME FROM PROGRAM CHAIRPERSONS Pamela Rose, RN, BSN, ASQ-CMQOE Barbara Godlew, RN Director Associate Director, Publication Clinical Trial Information Registries Coordination and Transparency Compliance TAP Pharmaceutical Products Inc. Exploratory Development Communications Novartis Pharmaceuticals Corporation 2 10:30 AM-12:00 PM SESSION 1 UNDERSTANDING A NEW STREET MAP: FDA REVITALIZATION ACT AND CLINICAL TRIAL DISCLOSURE FROM A LEGISLATURE'S CLINICAL TRIAL LANDSCAPE AND LIFECYCLE: POINT OF VIEW THE RELATIONSHIP BETWEEN DISCLOSURE AND THE Speaker Invited TRIAL PUBLICATION PLAN CHAIRPERSONS 3:00-3:30 PM REFRESHMENT BREAK Barbara Godlew, RN Robert Paarlberg, MS 3:30-5:00 PM SESSION 3 Director, Global Regulatory Policy and Intelligence, UCB, Inc. AFTER THE TRIAL IS COMPLETED: WHAT, WHEN, The relationship between clinical trial disclosure and the publication WHERE, AND HOW TO POST TRIAL RESULTS plan for congress abstracts/posters and completed study manuscript CHAIRPERSONS are closely intertwined. This session will examine some of the aspects Tracy Beck, PhD clinical teams should consider when writing a study protocol as well Global Medical Business Office Consultant; CTR Results as identifying key stakeholders to include in the publication planning Gatekeeper, Eli Lilly and Company process. Attendees will also gain knowledge on how the patients, Milen Vrabevski, MD families, and advocates view public disclosure of clinical trial proto- Medical Director/CEO, Comac Medical Ltd. cols and results and how public disclosure may impact publication planning. The biopharmaceutical industry has used clinical trial registries and results databases as one way to increase clinical trial transparency FROM THE EDITOR’S DESK: HOW MUCH IS TOO MUCH? and public trust. Up until recently, the emphasis has been on reg- Paul W. Ladenson, MD istering trials at initiation, but now the focus has shifted towards dis- Editor-in-Chief, The Journal of Clinical Endocrinology & closing results. This session will examine external stakeholders who Metabolism, The Endocrine Society are shaping the landscape of trial disclosure and what potholes to look out for. Attendees will learn what, when, and how to post LANDSCAPES AND LIFECYCLES: FROM THE PERSPECTIVE OF THE results summaries, as well as how to avoid risks of off-label promo- PUBLICATION PLAN tion when creating the summaries for public disclosure. Barbara Godlew, RN Robert Paarlberg, MS BRIEF OVERVIEW OF CURRENT REQUIREMENTS FOR POSTING RESULTS THE PATH TOWARDS ACCESS AND TRANSPARENCY: Pamela Rose, RN, BSN, ASQ-CMQOE THE PATIENTS’ POINT OF VIEW WHAT, WHERE, AND HOW TO POST RESULTS Pat Furlong Tracy Beck, PhD President, Parent Project Muscular Dystrophy HOW TO AVOID THE RISKS OF OFF-LABEL PROMOTION IN RESULTS SUMMARIES 12:00-1:30 PM LUNCHEON Bob Naidus, JD Senior Pharmaceutical Counsel, Novartis Pharmaceuticals 1:30-3:00 PM SESSION 2 Corporation STAKEHOLDER STREET MAPS: A WORLDWIDE OVERVIEW 5:30-6:45 PM NETWORKING RECEPTION TO CLINICAL TRIAL DISCLOSURE SPONSORED BY THE GOOD CLINICAL PRACTICES CHAIRPERSONS AND QUALITY ASSURANCE CLINICAL TRIAL Gerard Lynch DISCLOSURE WORKING GROUP AND THE Global Manager, AstraZeneca Clinical Trials Website CLINICAL RESEARCH, REGULATORY AFFAIRS AND Michael Rubison, PhD MEDICAL WRITING SPECIAL INTEREST AREA Senior Director, Global Medical Research and Registration, COMMUNITIES Abbott Laboratories This session provides an introduction to the major themes of the con- ference and provides an overview of the laws and policies associated WEDNESDAY • NOVEMBER 14 with transparency of clinical trial registration and results disclosure. This overview will include US federal and state legislation, interna- 7:30-8:30 AM REGISTRATION AND tional policies and institutional agreements for both required and CONTINENTAL BREAKFAST voluntary compliance, and the key issues that have driven clinical trial transparency. The international research and regulatory commu- 8:30-10:00 AM SESSION 4 nity has responded with a large array of databases and database standards proposed by international, national, regional healthcare READING AND FOLLOWING THE ROAD MAP: PUBLIC and regulatory groups, pharmaceutical companies, academic institu- REGISTRATION OF CLINICAL PROTOCOL INFORMATION tions, professional societies, patient advocate and therapeutic CHAIRPERSONS specialty groups. Barbara Godlew, RN Maureen Strange KEY MILESTONES AND ISSUES: A CHRONOLOGICAL HISTORY OF Associate Medical Business Operations Consultant; CTR Initiated CLINICAL TRIAL DISCLOSURE Gatekeeper, Eli Lilly and Company Gerard Lynch Michael Rubison, Phd Passed, pending, and proposed clinical trial registry legislation pro- vides an array of confusing and sometimes conflicting articles and 3 requirements for both the end users and the registry administrators. Pamela Rose, RN, BSN, ASQ-CMQOE This session will provide attendees with clarity on recent develop- State of Maine regulations require that publicly disclosed clinical ments in federal legislation and challenges the staff at the National trial information must be “reliable, accurate and true.” The FDA Library of Medicine face in complying with the requirements. Revitalization Act bill currently pending in Congress declares that clin- Attendees will also gain knowledge in the functional use of ical trial registry and results database information “shall not be false ClinicalTrials.gov as we build a record in the registry, step-by-step, or misleading in any particular.” Finally, the IFPMA statement on and answer audience questions during this process. clinical trial disclosure calls for companies to “establish a process of FINDING AND UNFOLDING THE MAP: LEGISLATION verification” and to “make public how they will adhere to” the stan- SURROUNDING CLINICALTRIALS.GOV dards defined in the statement. Collectively, these statements build a Rebecca Williams, PharmD compelling argument for instituting a robust audit program to assess Assistant Director, ClinicalTrials.gov, National Library your organization’s trial disclosures. This session includes an overview of Medicine of the key components comprising a sound clinical trial disclosure audit. The highlight of the session consists of a panel discussion YES! YOU CAN REGISTER A TRIAL TO CLINICALTRIALS.GOV featuring industry professionals who have been audited or have WITHOUT AGLOBAL POSITIONING SYSTEM AND WE’LL SHOW conducted audits of clinical trial disclosures. Attendees are invited YOU HOW !!! to come armed with their most pressing questions to pose to our Annice Bergeris Information Research Specialist, National Library of Medicine panelists on this timely and critical topic. Participants will leave this (assistance provided by Barbara Godlew and Maureen Strange) session with increased understanding and appreciation of how to prepare for, and what to expect during, a clinical disclosure audit. 10:00-10:30 AM REFRESHMENT BREAK PANELISTS 10:30 AM-12:00 PM SESSION 5 Auditee Perspective Shawn M. Pelletier HERDING CATS THROUGH CANYONS: DEVELOPING A Associate Director R&D Operations COMPANY PROCESS FOR PUBLIC DISCLOSURE Bristol-Myers Squibb Company CHAIRPERSONS Valerie V. Phillips, MA Margaret M. Cobb, MD, PhD Manager Clinical Trial Disclosure Global Leader of J & J Clinical Registry, Johnson & Johnson Pfizer Inc Pharmaceutical Research & Development, LLC Patricia Teden, MBA Auditor Perspective Independent Consultant John C. McKenney, Sr. Beat E. Widler, PhD Creating a business process that is accurate, predictable, and capable of Global Head of Clinical Quality Assurance meeting the changing needs for disclosing information about clinical trials F. Hoffmann-La Roche in multiple study registries and results databases is difficult. Companies need to leverage their current clinical trial process, determine if the disclo- sure steps will be centralized or decentralized, determine how much to 3:00-3:30 PM REFRESHMENT BREAK leverage technology, and decide whether, and how, to use outside resources. During this session, we will hear how a large pharma, a small 3:30-5:00 PM SESSION 7 biopharmaceutical company, and a device company developed their clini- cal trial disclosure business process. “EMERALDS OF EXPERIENCE” HERDING BIG PHARMA CATS … AVOIDING ACCIDENTS: CLINICAL TRIAL DISCLOSURE Margaret M. Cobb, MD, PhD LESSONS LEARNED CHAIRPERSON SMALL PHARMA: THE CATS WITH MANY HATS Anthony K. Taylor, Sr. Mary Kuskin, RPh Clinical Operations Coordinator, Targanta Therapeutics Director, Regulatory Affairs, Pharmalink Consulting Inc. Corporation The field of clinical trial disclosure has expanded dramatically in the last ten years. There has been a steady increase in the reach A DEVICE COMPANY AND COMBINATION PRODUCTS PERSPECTIVE Lisa Griffin Vincent, PhD, MA of stakeholders, regulations and experience on a global scale. The Senior Director, Corporate Clinical Research & Development, strategy for posting and maintaining clinical trial information finds a Medtronic Inc. place in the overall development and lifecycle strategy for biophar- maceutical and medical device companies. This session will highlight 12:00-1:30 PM LUNCHEON individuals’ experiences along this path to share the practical aspects of balancing regulation compliance with presentation of meaningful 1:30-3:00 PM SESSION 6 information on clinical trial databases. ARE YOU READY? PREPARING FOR AUDIT OF CLINICAL TRIAL DISCLOSURES CHAIRPERSONS 5:00 PM CONFERENCE ADJOURNED John C. McKenney, Sr. President & CEO, SEC Associates Inc. Statements made by speakers are their own opinion and not necessarily that of the organization they represent, or that of the Drug Information Association. Speakers and agenda are subject to change without notice. Recording of information, in any type of media, is prohibited at all DIA events without prior written consent from DIA. 4 “Emeralds of Experience” Information The Drug Information Association (DIA) is offering a unique opportunity for presenters at The Clinical Trial Disclosure “Emeralds of Experience” session is sched- the DIA Clinical Trial Disclosure conference in Weston, FL. uled for Wednesday, November 14, 2007 at 3:30 pm. A podium session will provide those in the clinical trial disclosure field an opportunity to Those interested in participating in the 15-minute podium presentation share their successes, challenges, and “Emeralds of Experience” on various topics with session should submit an abstract on the topic and information that their DIA Clinical Trial Disclosure colleagues. Participants can share their experiences and will be presented. Due to the limited time available for podium presen- “emeralds” by developing a 15-minute presentation. tations, only 4 (four) “Emeralds” will be accepted. A subset of the Suggested Abstract Topics: program committee will review and select from the topics submitted, if necessary. For those interested in submitting a poster, authors Stakeholder Street Maps: A Worldwide Overview to Clinical Trial Disclosure Law should submit an abstract according to the Guidelines for Abstract Reading and Following the Road Map: Public Registration of Clinical Protocol Submission below. Information After the Trial is Completed: What, When, Where, and How to Post Trial Results DEADLINE FOR SUBMISSIONS IS SEPTEMBER 17, 2007. Clinical Trial Landscape and Lifecycle: The Relationship between Registration and the Trial Publication Plan ALL ENTRIES MUST BE SUBMITTED ONLINE. Herding Cats through Canyons: Developing a Company Process for Public Disclosure http://www.diahome.org/DIAHOME/GetInvolved/ Are You Ready? Preparing for Audit of Public Disclosure Processes AbstractSubmissionLauncher.aspx Guidelines for Abstract Submission All abstracts must be received by September 17, 2007. Authors of selected abstracts 1. At time of electronic submission of abstracts, all speakers must will be notified by September 28, 2007. Please provide the following information complete the speaker disclosure section of the electronic submission using the online abstract form: form. 2. Preference will be given to submitted abstracts that address real-life PRIMARY TOPIC AREA applications and case studies. SPEAKER NAME (Degrees, job title) 3. Final PowerPoint presentation for all accepted abstracts will be due AFFILIATION (Mailing address, phone number, fax number, eMail) to DIA by October 23, 2007 to be reviewed by the committee and included in the attendee registration packet. Should you choose to PRESENTATION TITLE submit an abstract for consideration, please mark your calendars SUMMARY (approximately 2-3 sentences) suitable for inclusion in preliminary program, with this deadline. if selected 4. Final PowerPoint presentations for all accepted abstracts may have LEARNING OBJECTIVES (Please provide two learning objectives to inform the learner a company logo on slide number one. Any company logo appearing of what he/she should be able to do after attending your session. on any other slides will be removed by DIA. 5. Time allotted for individual presentations will be approximately ABSTRACT (300 words or less) 15-20 minutes. Final timing will be determined by the session chair and based on the number of presentations selected for the session. DISCLOSURE INFORMATION 6. DIA will provide complimentary conference attendance for the All speakers must disclose any significant financial interest or other relationship selected presenter. with the manufacturer(s) of any commercial product(s) and/or providers of commercial 7. Please note: Only one presenter per presentation will be allowed. services discussed in an educational presentation, as well as any discussion of Any exceptions to this policy must be discussed with the DIA office unlabeled or unapproved drugs or devices. in advance. TRAVEL AND HOTEL The most convenient airport is Fort Lauderdale/Hollywood UNITED AIRLINES & US AIRWAYS International Airport and attendees should make airline reservations as early as Save through Area Pricing and Discount Fees possible to ensure availability. The Hyatt Regency Bonaventure Conference Center and Spa is holding a block of rooms at the reduced rate below until To obtain schedule information and the best fares, call United Airlines’s October 22, 2007, for the DIA event attendees. Room availability at this rate Specialized Meeting Reservations Center at 1-800-521-4041. Make sure you is guaranteed only until this date or until the block is filled. refer to Meeting ID Number 571AK. Dedicated reservationists are on duty 7 Single $189 Double $214 days a week from 8:00 AM to 10:00 PM EST. Please contact the Conference Center by telephone at +1-954-616-1234 or This special offer applies to travel on domestic segments of all United Airlines, +1-800-233-1234 and mention the DIA event. The hotel is located at 250 United Express, PED, and United code share flights (UA*, operated by US Racquet Club Road, Weston, FL 33326, USA. Airways, US Airways Express and Air Canada). GROUP DISCOUNTS* Register 3 individuals from the same company and receive complimentary registration for a 4th! All 4 individuals must register and prepay at the same time – no exceptions. DIA will apply the value of the lowest applicable fee to this complimentary registration; it does NOT include fees for optional events or DIA mem- bership. You may substitute group participants of the same membership status at any time; however, administrative fees may be incurred. Group registration is not available online and does not apply to the already-discounted fees for government or charitable nonprofit/academia. To take advantage of this offer, please make a copy of this registration form for EACH of the four registrants from your company. Include the names of all four group registrants on each of the forms and return them together to DIA. Participants with Disabilities: DIA event facilities and overnight accommodations are accessible to persons with disabilities. Services will be made available to sensory-impaired persons attending the event if requested at least 15 days prior to event. Contact the DIA office to indicate your needs. 5 Drug Information Association www.diahome.org CLINICAL TRIAL DISCLOSURE CALL FOR ABSTRACTS “Emeralds of Experience” presentations learning the landscape and DUE BY SEPTEMBER 17 reading the roadmap 5 Co-located Events for Added Networking Opportunities! Hyatt Regency Bonaventure Conference DIA Outsourcing Summit Center and Spa, Weston, FL, USA Publication Writing and Building Partnerships PMI Pharmaceutical SIG/ DIA PM SIAC Joint Conference: The Future of NOVEMBER 13-14, 2007 | Event ID #07039 Pharmaceutical Project Management – Is a Paradigm Shift Needed? Winning Strategies for Achieving a Quality EDC Clinical Trial Process MEMBER EARLY BIRD Register by OCT. 23, 2007 SAVE $175 Register online or fax this page to +1-215-442-6199 DRUG INFORMATION ASSOCIATION 800 Enterprise Road, Suite 200 Horsham, PA 19044-3595 USA CONTACT & TABLETOP EXHIBIT INFORMATION Attendees may visit the tabletop exhibits during the event and during receptions (if applicable). Event information: Contact Ellen Diegel at the DIA office by telephone +1-215-442- 6158, fax +1-215-442-6199 or email Ellen.Diegel@diahome.org. Tabletop exhibit information: Contact Erin Gilliland, Exhibits Associate, at the DIA office by telephone +1-215-442-6149, fax +1-215-442-6199 or email Erin.Gilliland@ diahome.org. For tabletop exhibit space, please check the box below. To receive a tabletop exhibit application, please check. GROUP DISCOUNTS (not available online or on already discounted fees) Register 3 individuals from the same company and receive complimentary registration for a 4th! All 4 individuals must register and prepay at the same time – no exceptions. See page 5 for complete details. Registration Fees If DIA cannot verify your membership upon receipt of registration REGISTRATION FORM Do not remove mailing label. Please return this entire page. 07039 form, you will be charged the nonmember fee. Registration fee includes refreshment breaks, PLEASE CONSIDER THIS FORM AN INVOICE luncheons, and reception (if applicable), and will be accepted by mail, fax, or online. Please check the applicable category: Academia Government Industry CSO Student (Call for registration information) MEMBER EARLY-BIRD OPPORTUNITY On or before After Available on nondiscount member fee only OCT. 23, 2007 OCT. 23, 2007 Last Name Check if part of group registration First Name M.I. 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Group Registrant #3 Last Name First Name Completed form required for each group registrant CANCELLATION POLICY: On or before NOVEMBER 6, 2007 Group Registrant #4 Last Name First Name Completed form required for each group registrant Administrative fee that will be withheld from refund amount: Member or Nonmember = $200 PAYMENT OPTIONS Register online at www.diahome.org or check payment method Government or Academia or Nonprofit (Member or Nonmember) = $100 CREDIT CARD number may be faxed to: +1-215-442-6199. You may prefer to pay by check or bank transfer since Tutorial (if applicable) = $50 non-U.S. credit card payment will be subject to the currency conversion rate at the time of the charge. Cancellations must be in writing and be received by the cancellation date above. Visa MC AMEX Exp Date _______________________________________ Registrants who do not cancel by that date and do not attend will be responsible for the full registration fee paid. 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Please include a copy of this registration form to facilitate identification DIA is not responsible for any airfare, hotel or other costs incurred by registrants. of attendee. I cannot attend but please keep me informed of DIA’s future events. BANK TRANSFER When DIA completes your registration, an email will be sent to the address on the registration form with instructions on how to complete the Bank Transfer. Payment should be made in US dollars. Your name and company, (requires completion of name, postal address and email address on this form) as well as the Event I.D. # must be included on the transfer document to ensure payment to your account.