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2014-2015 Bio-Trac Stem Cell Workshop Registration Form
Co-Sponsored by the NIH Center for Regenerative Medicine
$995 (Feb. 2, 2015)
Name (first, middle initial, last )
Name of Institution, Government Agency or Company
Department, Building and Room Number
City, State, Zip
Home Address - Street
Home Address - City, State, Zip
Date of Birth (DD/MM/YYYY)
Phone Number (Evening, Daytime)
Tuition Enclosed $_________
Full tuition must accompany registration form.
Payment Type :
Check - payable to FAES
Credit Card: VISA MasterCard
Name on the Card
Security Code on Back
City, State, Zip
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: 301-496-7975 (Ms. Carline Coote)
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. Carline Coote
If Paying by Government Training Authorization Form (SF-182)
Print out and mail registration form along with original training authorization form to:
Ms. Carline Coote
National Institutes of Health
FAES Admin Office
10 Center Drive, Room 1N241 - MSC 1115
Bethesda, MD 20814-1460
Please note: We cannot accept SF-182 forms via fax.
Registration forms can also be hand delivered to building 10, room Room 1N241 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 email@example.com regarding any inquiries
Biotechnology Training Courses at the National Institutes of Health
Sponsored by the Foundation for Advanced Education in the Sciences