Registration

NTUMCAA 29th Annual Convention Registration Form

August 14 -16, Queens Crossing, Flushing, New York

Print Registration Form

2009年北美臺大醫學院校友會年會報名單

(For updated info: http://www.hpeng.net/ntumcaa/index.html)

Name of Member

Dr. Mr. Mrs. Ms. (English) ________________________________ (Chinese) ___________

醫學牙醫藥學護理復健醫技 Year of Graduation: __________

Specialty: _______________________________________________________________ Retired

Address: _______________________________________________________________ Private

Phone: _____________________ Private E-mail: _____________________________ Private

Name of Guest

Dr. Mr. Mrs. Ms. (English) ________________________________ (Chinese) ___________

Relationship: ______________________ NTUMC alumnus/alumna? Yes No

醫學牙醫藥學護理復健醫技 Year of Graduation: __________

Registration Fees

　 Unit Charge # of Persons Subtotal

Regular Member (Included are meeting registration, 2 breakfasts, 1 lunch and the dinner banquet.)

Early Bird $200 × $

After June 1^st , 2009 $230 × $

Member in Training (Discounted fees for graduate student, resident, fellow, etc. All meals included. )

Early Bird $70 × $

After June 1^st , 2009 $90 × $

Spouse/Guests

Breakfast 08/15/09 $10 × $

Lunch 08/15/09 $35 × $

Dinner Banquet 08/15/09 $80 × $

Breakfast 08/16/09 $10 × $

Post-Convention Tours

New York - Lake George
08/16/09 - 08/18/09
☐ $685/person, double occupancy
☐ $925/person, single occupancy
× $

Golf Tournament 08/14/09 $100/ person × $

Donation (A letter to acknowledge your contribution will be sent to you.) $

Total (Make one check payable to NTUMCAA-NA.) $

　

Print Registration Form

Hotel:
Sheraton LaGuardia East Hotel (Group rate $149 plus tax per night)
135-20 39th Avenue, Flushing, New York 11354
Phone: (718) 460-6666
Please make your own reservation before July 14, 2009. Mention event of NTUMCAA.

Mail: Mail checks and registration form to Ching-Huang Huang, M.D., 60 Old Ridge Road, Warwick, NY 10990 before June 1st, 2009.

Refund/Cancellation Policy: Cancellation request should be in writing and postmarked by July 15, 2009 to avoid a 10% charge.

Questions: Ching-Huang Huang, M.D.
60 Old Ridge Road, Warwick, NY 10990, USA

Tel: 845-986-3214; E-mail: NTUMCAA.NA.GNY@gmail.com

		Unit Charge	# of Persons	Subtotal
Regular Member (Included are meeting registration, 2 breakfasts, 1 lunch and the dinner banquet.)
Early Bird		$200	×	$
After June 1^st , 2009		$230	×	$
Member in Training (Discounted fees for graduate student, resident, fellow, etc. All meals included. )
Early Bird		$70	×	$
After June 1^st , 2009		$90	×	$
Spouse/Guests
Breakfast 08/15/09		$10	×	$
Lunch 08/15/09		$35	×	$
Dinner Banquet 08/15/09		$80	×	$
Breakfast 08/16/09		$10	×	$
Post-Convention Tours
New York - Lake George 08/16/09 - 08/18/09	☐ $685/person, double occupancy ☐ $925/person, single occupancy		×	$
Golf Tournament 08/14/09		$100/ person	×	$
Donation (A letter to acknowledge your contribution will be sent to you.)				$
Total (Make one check payable to *NTUMCAA-NA*.)				$