UH Hilo College of Pharmacy Accreditation and Education Conference, 2011 Registration Form

Hilton Waikoloa Village
Waikoloa, Island of Hawaiʻi

February 4–5, 2011

Attendance Confirmation Form (One Participant per Form)

To confirm your attendance for this conference, please:

Complete and submit your information in the online form below.
Your attendance will be confirmed after we receive your submission and payment or payment authorization for any guest meal purchases.

Please note: The deadline to submit your form is January 15, 2011 (Midnight Hawaiian Standard Time). Please remit payment for guest meal purchases by January 25, 2011.

Cancellation Policy

All cancellation requests must be received in writing to cop@hawaii.edu.
No refunds will be provided for cancellations received after January 25, 2011.
Refunds will be processed within 4 weeks after the completion of the UH Hilo College of Pharmacy Accreditation and Education Conference, 2011.

Required fields are marked.

Section 1: Personal Information

Last (Family) Name:
First Name:
Middle Initial:
Title:
Affiliation:
Phone:
Fax:
Email Address:
Mailing Address:
Address (line 2):
City:
Province/State:
Postal code:
Country:
Badge Name:	Enter your name as you wish it to appear on your badge (e.g., John Doe):
Special Needs:	Do you have special needs during the conference? Yes No If you need special arrangements due to diet or disability, please contact the UH Hilo Conference Center at cop@hawaii.edu before January 25, 2011.

Section 2: Conference Registration

Please Check Yes or No, as to whether you will be attending the following functions:

Friday, February 4, 2011 6:30 - 7:30pm; Dinner Reception (hosted by the UH Hilo College of Pharmacy)
- Yes, I will be attending
- No, I regretfully decline
Saturday, February 5, 2011 7:00am - 4:00pm Full day of Conference Activities; Includes Breakfast Buffet, AM and PM Refreshments, and Lunch (All meals are hosted by the UH Hilo College of Pharmacy)
- Yes, I will be attending
- No, I regretfully decline

Section 3: Guest Options

The Dinner Reception on the night of February 4, 2011 is open to spouses and guests. Guest meals can be purchased for $75.00 each. Please contact the UH Hilo Conference Center for more than 3 guests: cop@hawaii.edu

Guest 1

Guest 1 name (last, first):

Friday, February 4, 2011

$75 - Dinner Reception

Guest 2

Guest 2 name (last, first):

Friday, February 4, 2011

$75 - Dinner Reception

Guest 3

Guest 3 name (last, first):

Friday, February 4, 2011

$75 - Dinner Reception