REGISTRATION FORM

Fifteenth International Conference on Cognitive and Neural Systems

May 1114, 2011

Boston University

Department of Cognitive and Neural Systems

677 Beacon Street

Boston, Massachusetts 02215 USA

Fax: +1 617 353 7755

 

Mr/Ms/Dr/Prof:_____________________________________________________

 

Affiliation:_________________________________________________________

 

Address:__________________________________________________________

 

City, State, Postal Code:______________________________________________

 

Phone and Fax:_____________________________________________________

 

Email:____________________________________________________________

 

 

The registration fee includes a copy of the conference proceedings volume, a reception on Friday night, and 3 coffee breaks each day.

 

CHECK ONE:

( ) $150 Conference (Regular)

( ) $95 Conference (Student)

 

METHOD OF PAYMENT:

[ ] Enclosed is a check made payable to "Boston University"

Checks must be made payable in US dollars and issued by a US correspondent bank. Each registrant is responsible for any and all bank charges.

 

[ ] I wish to pay by credit card

(MasterCard, Visa, or Discover Card only)

 

Name as it appears on the card:___________________________________________

 

Type of card: _____________________________ Expiration date:________________

 

Account number: _______________________________________________________

 

Signature:____________________________________________________________