Registration Form

12th National American Synesthesia Association, Inc.
Conference at Harvard University
October 6 – 8, 2017

Registration for the conference is necessary for all who wish to attend. Please note that seating in the GeoHall is limited.

All selected presenters who are US citizens must be members of the American Synesthesia Association, Inc.

Harvard Requirement: No Program participant shall be under the age of 18 unless accompanied by a parent or guardian.


Early Registration Fees Received on or before August 15, 2017

$175.00 (ASA Members)
$175.00 (All Harvard Faculty)
$225.00 (Non Members)
$ 60.00 (Students with current valid ID)


Registration Fees Received after August 16, 2017

$225.00 (ASA Members)
$225.00 (All Harvard Faculty)
$275.00 (Non Members)
$ 60.00 (Students with current valid ID)


For information about becoming an ASA Member, please click here.



Method of payment:
Registration Fees are payable in USD
Note: You do not need to pay via a Paypal account; simple click the "Pay with Debit or Credit Card."


Via credit card:

Registration

ASA Members $225.00 USD All Harvard Faculty $225.00 USD Non Members $275.00 USD Students with current valid ID $60.00 USD

Name of Conference Attendee

Note: You do not need to pay via a Paypal account; simply click the "Pay with Debit or Credit Card." Refunds for cancellations will not be issued after September 15, 2017.


Via check or money order:


First Name: _______________________________________________________________

Last Name: _______________________________________________________________

Street Address: ____________________________________________________________

City, State, Postal Code: _____________________________________________________

Country: __________________________________________________________________

Telephone Number: _________________________________________________________

E-mail Address: ____________________________________________________________



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

Mail to:
The American Synesthesia Association, Inc.
90 Morningside Drive, 3B
New York, NY 10027
USA