Alcor 2002 Conference Registration Form

The conference is over

This page is purely archival

Fifth Alcor Conference on
Extreme Life Extension
November 15-17 2002

PRINT then fax or mail this form to:
Alcor Life Extension Foundation
7895 E. Acoma Dr., #110
Scottsdale, AZ 85260
Tel: 877-462-5267 Fax: 480-922-9027

Conference Registration Fees

By September 30th

After September 30th

After November 1st

With lunches, with Friday Night Reception

$475.00

$575.00

$625.00

Without lunches, without Friday Night Reception

$375.00

$475.00

$525.00

Tutorial Registration Fee (separate from conference)

$295.00

$395.00

$445.00

Contact Information

Name: _________________________________________________________

Organizational Affiliation (for your badge): ___________________________

Address: _______________________________________________________

City: ___________________________________ Zip/Postal Code: ______________

State:_____________ Country:_________ Email:_______________________________

Phone: ___________________________________ Fax: ___________________________________

How did you hear about this conference?___________________________________

 ___Do not include my contact information on the attendee list.

Payment Information

Make checks payable to Alcor. Checks and bank drafts must be in U.S. dollars drawn on a U.S. bank.

Name as it appears on credit card:_______________________________________________________

Credit card number(VISA/MC/AMEX):______________________________________________________

Expiration date:__________________________

Print then fill out this form and fax or mail to Alcor. A separate form is required for each person attending the conference.
Or register by phone by calling Alcor at 800-482-6791