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Working together to provide research,
education, and support for people
affected by Primary Sclerosing Cholangitis

PSC Partners Seeking a Cure - 2005 Conference Registration Form

When: April 29, 2005 (5:00 PM) - May 1, 2005 (Noon)

Where: Grand Hyatt Denver [http://granddenver.hyatt.com/property/index.jhtml]

Conference schedule: See http://www.pscpartners.org/Conf2005.htm

To register, please print and complete this form and send it with a check to this address:

    PSC Partners Seeking a Cure
    5237 S. Kenton Way
    Englewood, CO 80111

Please make all checks payable to:

    Pay to the Order Of: PSC Partners Seeking a Cure
    (Sorry, we cannot accept credit cards)

Conference fees:

  • Early-bird conference fee is $160 per person or $300 per couple if you register BEFORE March 31, 2005

  • Late conference fee is $170 per person or $320 per couple if you register AFTER March 31, 2005

NAMES OF PEOPLE ATTENDING: (First and last names)

    1. _______________________________________

    2. _______________________________________

E-MAIL ADDRESS: ______________________________________________

HOME ADDRESS: _________________________________________________

    ______________________________________________________________________

HOME PHONE: __________________________________

CELL PHONE: __________________________________

NAME OF PERSON WITH PSC: _____________________________________

HOW DID YOU HEAR ABOUT THIS CONFERENCE? _____________________

    ______________________________________________________________________

WOULD YOU BE WILLING TO VOLUNTEER WITH REGISTRATION OR OTHER SHORT DUTIES AT THE CONFERENCE?
    YES_______ NO_______

AMOUNT ENCLOSED (CHECKS ONLY)

  • If received before March 31, 2005: $160 per person or $300 per couple

    TOTAL: ________________

  • If received after March 31, 2005: $170 per person or $320 per couple

    TOTAL: ________________

Conference registration fee receipts will be sent to your e-mail address. If you don’t have an e-mail address and would like a receipt, please include a stamped self-addressed envelope with your registration form and check.

IMPORTANT HOTEL INFORMATION:

The Grand Hyatt is now completely booked for the April 29 weekend. An alternative hotel is the Marriott City Center at 1701 California, Denver, CO, only one short block from the Grand Hyatt. The Marriott is offering a group rate of $109 per room per night, and their cutoff date is April 15, so act soon! To make a reservation, you may either call central reservations at 800 228-9290 or call the hotel directly at 303 297-1300. When you make the reservation, be sure to ask for the group rate for PSC Partners Seeking a Cure.

If you have any questions, please send an e-mail to contactus@pscpartners.org.

Thank you for attending the conference. We think it will be a very informative and exciting weekend. We look forward to meeting you.

2005 Conference Organizers

PSC Partners Seeking a Cure (www.pscpartners.org)
Don and Ricky Safer
contactus@pscpartners.org


Last Update: 07/12/08