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Mason AGEP Registration Form
Mason AGEP Registration Form
AGEP Registration
Please complete the following information. Please note that you are not enrolled in the program until you receive confirmation of acceptance.
Please indicate for which program you are applying.
AGEP Public Policy Conference: The Pharmaceutical Industry: Economics, Regulation and Legal Issues, May 2-May 4, 2012
AGEP 2nd Annual Policy Institute on Financial Services Regulation, June 3 - June 5, 2012
AGEP Public Policy Institute, September 30 - October 3, 2012
AGEP Public Policy Conference on Comsumer Protection, October 21-23, 2012
Name
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First
Last
Title
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Business Address
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Business Address 2
City
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State
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Zip
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Business Phone
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Fax
Email
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Public Policy Institute Attended:
Month/Year
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Location
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If you are applying for an Advanced Institute, but have not yet attended a Public Policy Institute, please explain why the Institute is relevant to your legal experience and/or practice:
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First Name or Nickname for Nametag
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Room Preference
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King
Double/Double
Complete a one-page biography (feel free to cut and paste from an existing biography)
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For use in our program book.
Please read before submitting:
I understand that limited spaces are available for these programs and that my registration means that another person will not be able to attend. My registration also means that I have definite plans to attend the program. I understand that I will be personally responsible for meal expenses other than those associated with group meals. I understand that I will be reimbursed for qualifying travel expenses up to a total reimbursement of $500 for the program. For qualifying travel expenses exceeding $500, the AGEP will reimburse 50% of the marginal amount exceeding $500 (for example, for expenses totaling $750, the AGEP will reimburse $500, plus 50% of the additional $250, for a total reimbursement of $625.) For persons traveling from Alaska and Hawaii, the AGEP will reimburse qualifying travel expenses up to $1,000, plus 50% of the marginal amount exceeding $1,000. Reimbursement is made upon successful completion of the program attended. Qualifying travel expenses include coach airfare, ground transportation, and parking associated with travel to and from the program. Meals are not included. I understand that I will be responsible for any expenses associated with spouse/guest travel, meals, and lodging. I understand that if I am traveling from the Mountain Time Zone or further west, I am eligible for an additional hotel night at the front end of the program to facilitate on-time arrival. I agree to read the assigned materials prior to class, attend all class and group functions promptly, and participate in classroom discussions and activities. I agree to make travel arrangements so that I am present for all sessions, including the opening and closing sessions. In general, my flights will arrive two hours before the start of the program and leave three hours after the end of the program.
Untitled
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I agree