MARCUMS 2018 Conference
Member and Non-Member Attendees please fill out this registration for Online Payment.
Join colleagues on October 16 & 17, 2018 at Bucknell University for the MARCUMS 20th Anniversary Conference.
Company
*
Attendee Name
*
First Name
Last Name
Attendee Title
Attendee Email
*
example@example.com
First Time Conference Attendee
*
Yes
No
Food Allergy
None
Other
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Additional Attendees
MARCUMS members may bring additional attendees from their department at the member rate.
Attendee #2 Name
First Name
Last Name
Attendee #2 Title
Attendee #2 Email
example@example.com
Attendee #2 First Time Conference Attendee
Yes
No
Attendee #2 Food Allergy
None
Other
Attendee #3 Name
First Name
Last Name
Attendee #3 Title
Attendee #3 Email
example@example.com
Attendee #3 First Time Conference Attendee
Yes
No
Attendee #3 Food Allergy
None
Other
Attendee #4 Name
First Name
Last Name
Attendee #4 Title
Attendee #4 Email
example@example.com
Attendee #4 First Time Conference Attendee
Yes
No
Attendee #4 Food Allergy
None
Other
Attendee #5 Name
First Name
Last Name
Attendee #5 Title
Attendee #5 Email
example@example.com
Attendee #5 First Time Conference Attendee
Yes
No
Attendee #5 Food Allergy
None
Other
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Guests
Guests are spouses or partners who you wish to attend the reception and dinner on Tuesday evening October 16, 2018.
Name Guest 1
First Name
Last Name
Guest 1 Food Allergy
None
Other
Name Guest 2
First Name
Last Name
Guest 2 Food Allergy
None
Other
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Online Payment
Registration Fees
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Member Registration Fee
$150.00
$
150.00
Quantity
0
1
2
3
4
5
Item subtotal:
$0.00
$
0.00
Non Member Registration Fee
$200.00
$
200.00
Quantity
0
1
2
3
4
5
Item subtotal:
$0.00
$
0.00
Guest Dinner Fee
$50.00
$
50.00
Quantity
0
1
2
Subtotal
$0.00
$
0.00
Shipping
$0.00
$
0.00
Total
$0.00
$
0.00
Submit
Should be Empty: