6th ASM Conference on Candida and Candidiasis January 13-17, 2002
Tampa, Florida

Speaker Registration Form

Registration Deadline: December 12, 2001      
This is not an interactive form. Please print the page, complete,
and return it via fax.

Name:____________________________________________________________

Organization/Institution:_______________________________________________________

Department:________________________________________________________________

Address:__________________________________________________________________

City, State/Province:__________________________________________________________

Zip:_____________________________   Country:__________________________________
                                                       
Telephone:____________________________Fax Number:____________________________

E-mail Address:______________________________________________________________


2. Do you need any special A/V equipment for your presentation?

The General Sessions will be equipped with the following:

Slide Projector
Data/LCD Projector (you supply your own laptop)
Remote control
Screen
Microphone(s)
Overhead Projector
Laser Pointer

____I do not require any additional equipment.

____For my presentation, I will also require:

__________________________________________________________________________

When complete, fax this form to ASM Conferences at 202/942-9340.