ISID 2023

REGISTRATION FORM

May 10-13, 2023

GENDERATTENDEE INFORMATION

AFFILIATION(Check all that apply) Female Male Non-Binary / Third Gender Prefer to self-describe _________ Prefer not to answer this question He/him/his
 She/her/hers They/them/theirs
 Prefer to self-describe _________

 ASDR Member
 ESDR Member
 JSID Member
 KSID Member
 SID Member Pre-Doctoral Student Post-Doctoral Fellow
 Resident
 Other __________________

Institution _________________________________________________________

RACE/ETHNICITY

DEGREE

Address ___________________________________________________________

 American Indian or Alaska Native Asian Black, African American or

 MD
 PhD
 PhD Candidate
 Pre-Doctoral Student
 Other __________________First Name ________________________________________________________
Last Name ________________________________________________________GENDER PRONOUN

Degree ______________________________ Title ________________________
Department _______________________________________________________

Afro-Caribbean

City ______________________________________ State __________________

 Hispanic or Latino
 Native Hawaiian or

Zip/Postal Code ______________________ Country _____________________

Other Pacific Islander

Phone_________________________________ Fax ________________________

 Middle Eastern or North African White Other not listed here (please specify)

Email _____________________________________________________________ Prefer not to answer this question

COMMUNICATIONS
I would like to receive e-mailcorrespondence from the ISID
regarding Annual Meeting
Information and Updates.
 Yes No________________________________First-time Attendee?  Yes  No

REGISTRATION FEESPAYMENT INFORMATIONREGISTRATION CATEGORIES

ON/BEFORE
4/14/23

ON/AFTER
4/15/23

ISID Society Member (ASDR, ESDR, JSID, KSID, SID, TSID)* $400 $550Non-Member $650 $750

Low and Lower Middle Income Countries (LMI) Member** $230 $300

Low and Lower Middle Income Countries (LMI) Non-Member** $300 $400Student/Resident/Fellow ISID Society Member $230 $300Student/Resident/Fellow/Administrator/
Lab Technician Non-Member*** $300

 $400

Low and Lower Middle Income Countries (LMI)
Student/Resident/Fellow Member** $150 $200

Enclose a check in US dollars drawn on a
US bank made payable to the ISID, or supply
credit card information below.

Low and Lower Middle Income Countries (LMI)**
Student/Resident/Fellow/Administrator/Lab Technician
Non-Member***Check #: _______________________________________
Payment by check saves the ISID 5% credit card
processing fees.

 Visa Mastercard

 American Express

Card #: _________________________________________
CVV* __________ Expiration Date: ______ /______*Security Code

Authorized Signature $220 $300________________________________________________Name on Card

EVENTS
Social Gathering

Total: $ _________________________________________

 $35________________________________________________
Billing Address for Card (if different fromattendee information)________________________________________________

***
***		

Registration in this category is pending verification by the ISID Office of a valid membership with the home society.
Updated list of LMI countries can be found here: https://wellcome.org/grant-funding/guidance/low-and-middle-income-countries
Non-Member Residents, Post-Doctoral Fellows and Pre-Doctoral Students must mail or fax to the ISID office a letter from theirdepartment verifying their status. Letters must be signed and on official university/institution letterhead.

All cancellations and changes to ISID 2023 registration must be made in writing to the SID office, by Friday, April 14, 2023. Cancellations
made after Friday, April 14, 2023, will not receive a refund. No exceptions can be made. Refunds are issued after the meeting, less a $100
administrative fee.

________________________________________________________________________________________________