REGISTRATION FORM

REGISTRATION

Practicing pathologist: $750 BEFORE May 1, 2008
$850 AFTER May 1, 2008

Pathologist in training: $650 BEFORE May 1, 2008
$750 AFTER May 1, 2008

To register, complete this form and mail with check, money order or cashier’s check.

Visa/Mastercard accepted. 

Name on credit card: ________________________________

Credit card #: ______________________________________

Expiration date: ____________________________________

Signature: _________________________________________

Make checks payable to:

University of Hawaii 

Mail or Fax to registration to: Fax: (808) 973-1401

Karen S. Thompson, MD

Kapiolani Medical Center for Women and Children

Department of Pathology

1319 Punahou St.

Honolulu, HI 96826

Early registration is recommended.  A $75 processing fee will be charged for

cancellation up to May 8^th 2008; no refunds will be given after that time

unless your place can be filled.

Amount Enclosed ___________________________________

Name ____________________________________________  

Preferred 1st name on nametag   ________________________

Address __________________________________________

_________________________________________________

City/State/Zip + ____________________________________

Phone __________________ Fax _____________________

E-mail (for registration confirmation and information update)

_________________________________________________

LUAU BUFFET DINNER AND SHOW RESERVATIONS:

Reservations need to be made in advance.

Money to be collected at conference registration. 

Includes transportation.

Indicate # attending:_____Adults ($100) _____ Children ($70)

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