BTEC CONFERENCE REGISTRATION

> ***Moving Forward in Childhood and Adult Brain Tumor***
> ***Epidemiology***
>
> **April 5-7, 2008 -- Heidelberg**
>
> **Heidelberg Marriott Hotel**
>
> **Vangerowstrasse 16**
>
> **69115 Germany**

**Registration Deadline: January 12, 2008**

# Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ E-mail:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**(Name as to be printed on conference badge)**

**Institution/Organization:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Department:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Speciality:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Country:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Phone:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

## Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Fax:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

## City:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_State/Province:\_\_\_\_\_\_\_\_\_\_\_Postal Code:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Room request: \_\_\_\_\_\_single \_\_\_\_\_\_double
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_roommate**

**Dates: April 5\_\_\_\_\_\_\_\_ April 6\_\_\_\_\_\_\_\_**

**Special requirements (meals or
services).\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

The Brain Tumor Epidemiology Consortium is a self-directing consortium
empowered by its commitment to find

"innovative" collaborations that will lead to a better understanding of
the etiology, prevention and outcomes of brain tumors.

**Registration fees include \$25 per night toward housing on April 5 &
6, breakfast, lunch and dinner on April 6 and breakfast on April 7.**
Rooms have been reserved at the Marriott Hotel
([www.marriotthotels.com/hdbmc](http://www.marriotthotels.com/hdbmc))

and are available on a first come basis at \$115 euros for single or
double occupancy (includes \$25 BTEC subsidy per person per night).
There is a substantial savings if you book with a roommate. BTEC will
book rooms when registration and payment are received. Please list your
roommate if you request a double on the registration form. We can also
help you locate a roommate. Additional nights are **[not]{.underline}**
the responsibility of BTEC but may be arranged directly with the hotel
by calling +49-6221-9080.

**Abstracts:** may be submitted to Dr. Brigitte Schlehofer,
<b.schlehofer@dkfz-heidelberg.de> (see attached information)

**Conference Registration DEADLINE: January 12, 2008 [\$125.00 US
Funds]{.underline}**

**To register**: **Please complete and return the registration form** to
Carol Kruchko, BTEC Secretary/Treasurer by email <cbtrus@aol.com>. You
may also fax the form to 630-655-1756 or send by mail along with the
registration fees.

**PAYMENT METHOD: Check, money order or wire transfer made payable to
BTEC**

**WIRE TRANSFER INSTRUCTIONS**

**Northern Trust Company, 50 S. LaSalle, Chicago, IL 60675**

**Swift Code: CNORUS44 Bank Routing Number: 071000152**

**Credit Account: 2404737 Central Brain Tumor Registry of the United
States**

**[Mail registration form and check to:]{.underline} Jeri Dolan, CBTRUS
Administrative Assistant, 244 East Ogden, Suite 116, Hinsdale, IL 60521.
We would also appreciate an additional confirmation by email or fax of
the registration form as indicated under "to register".**