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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




Without lunches, without Friday Night Reception




Tutorial Registration Fee (separate from conference)





___I will attend the conference with lunches and with the Friday Night Reception

___I will attend the conference without lunches and without the Friday Night Reception
___I will attend the tutorial on Friday (Friday lunch is included)

___Send me an Alcor Membership Application Form (the $150 Application Fee is waived for conference attendees)

Registrations after 12:00 noon on Wednesday, November 13th must be in-person at the conference site. Registrations after midnight on Sunday November 10th will not include the Friday night reception or the Saturday/Sunday lunches except on a space-available basis.

The total amount of my payment is:________________________



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