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Registration Form


11th Annual National American Synesthesia Association, Inc.
Conference at the University of Miami, Florida
October 2–4, 2015

Registration for the conference is necessary for all who wish to attend.

All selected presenters who are US residents must be members of the American Synesthesia Association.

Early Registration Fees Received before June 12, 2015

$140.00 (ASA Members)
$140.00 (All University of Miami Faculty)
$185.00 (Non Members)
$ 50.00 (Students with current valid ID)


Registration Fees between June 13, 2015 and August 17, 2015

$175.00 (ASA Members)
$175.00 (All University of Miami Faculty)
$230.00 (Non Members)
$ 50.00 (Students with current valid ID)


Registration Fees after August 17, 2015

$200.00 (ASA Members)
$200.00 (All University of Miami Faculty)
$250.00 (Non Members)
$ 50.00 (Students with current valid ID)



Method of payment:

Registration Fees are payable in American Dollars.


First Name: _______________________________________________________________

Last Name: _______________________________________________________________

Street Address: ____________________________________________________________

City, State, Postal Code: _____________________________________________________

Country: __________________________________________________________________

Telephone Number: _________________________________________________________

Fax Number: ______________________________________________________________

E-mail Address: ____________________________________________________________

Website: __________________________________________________________________


Please print out a copy of this registration form, fill it out, and either bring it with you, or send it with your check or money order to:

American Synesthesia Association, Inc.
75 East 4th Street, Suite 573
New York, NY 10003
USA


Please make your check or money order payable to the American Synesthesia Association, Inc.

Confirmation of receipt will be by email only.

The ASA cannot be held responsible for registrations that are not received in a timely manner.



Photo Credit Berit Brogaard, Miami Sunset