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2013 Bio-Trac/CRM Stem Cell Workshop Registration Form Co-Sponsored by the NIH Center for Regenerative Medicine
Contact Information Name (first, middle initial, last ) Name of Institution, Government Agency or Company Department, Building and Room Number Street Address City, State, Zip Home Address - Street Home Address - City, State, Zip email Date of Birth (DD/MM/YYYY) Highest Degree Phone Number (Evening, Daytime)
Tuition Tuition Enclosed $_________ Full tuition must accompany registration form.
Payment Type : Check - payable to FAES Training Form Credit Card: VISA MasterCard
Card Number Exp. Date Name on the Card Security Code on Back Cardholder Information Street Address City, State, Zip email phonel
Authorized Signature_____________________________
The FAES does not discriminate on the basis of race, color, religion, sex, age, handicap, national or ethnic origin or veteran status, in administration of its educational policies, admissions policies, scholarship programs, and other educational programs.
Registration Information - FAES: 301-496-2316 (Candice Allar) Workshop Information - 301-496-8290 (Mark Nardone)
We currently do not take online payments
If Paying by Cedit Card Fax Registration form (301-402-0174) along with credit card information to the FAES office, Attn: Ms. Candice Allar If Paying by Government Training Authorization Form (SF-182) Print out and mail registration form along with original training authorization form to: Ms. Candice Allar Bio-Trac Registrar FAES/NIH One Cloister Court Bldg. 60, Rm 237 Bethesda, MD 20814-1460 Please note: We cannot accept SF-182 forms via fax.
Registration forms can also be hand delivered to building 60, room 237 on the NIH campus. Our hours of operation are 8:30 - 4:00 - Mon - Fri.
Bio-Trac Refund Policy
1. 100% tuition refund is available for registrations cancelled 14 or more days prior to the start of the workshop. 2. 50% tuition refund is available for registrations cancelled between 4 to 13 days prior to the start of the workshop. Instead of a partial refund, you may elect to take a full workshop credit, which can be applied to another Bio-Trac program of similar length. 3. No refund is available for registrations cancelled 3 days or less prior to the start of the workshop. A full workshop credit will be available to you, which can be applied to another Bio-Trac program of similar length. All cancellations must be received in writing via fax to the FAES office, Attn. Ms. Bea Sonnenberg; Bio-Trac Registrar 301-402-0174 during normal business hours (8:30 4:30 EST). Those received after hours are time marked for the following day. In the case of situation numbers 2 or 3, you must indicate whether you are opting for the full credit alternative at the time of written cancellation. In both cases, all payments will be processed by the start of the initial workshop.
Bio-Trac DVD Orders1. DVDs are only being made available for purchase to class participants
2. DVDs will be shipped within 10 days after the conclusion of the program.
3. All riights reserved, unlawful to duplicate or distribute to others.
4. FAES will accept payment via credit card or check, SF182 forms cannot be accepted for DVD purchase.
5. Please contact Mark Nardone at 301-496-8290 or nardonem@mail.nih.gov regarding any inquiries
Biotechnology Training Courses at the National Institutes of Health Sponsored by the Foundation for Advanced Education in the Sciences