12th Biennial Symposium on Statistical Methods
REGISTRATIONFORM
April 7–8, 2009 (Short Courses April 6)
Holiday Inn Conference Center, Decatur, Georgia

www.cdc.gov/sag
INSTRUCTIONS
1. Print or type all information and retain a copy for your records.
REGISTRATION FEES

2. Use a separate form for each registrant.
SYMPOSIUM
3. Mail form with payment to CDCSY Registration, c/o American
❑ Regular Registrant $50 $_______
Statistical Association, 732 North Washington Street,
Alexandria, VA 22314. Fax form (credit card only) to
❑ CDC/ATSDR Federal Employee no charge
(703) 684-2037. ❑ Student (with valid ID) $25 $_______
4. Registration form must be received by March 24, 2009, to print
and ship registration packets. Forms received after March 24,
ShORT COURSES
2009, will not be processed.
SC1: 8:30 a.m.–12:00 p.m. Methodological Issues in
Forms Received Without Payment Will Not Be Processed
Biosurveillance—Ron Fricker
❑ Regular Registrant $125 $_______
ATTENDEE INFORMATION
❑ CDC/ATSDR Federal Employee no charge
❑ Student (with valid ID) - $75 $_______

Name
SC2: 1:00 p.m.– 4:30 p.m. Information Visualization—
Wendy Martinez
Government ID # (if known)
❑ Regular Registrant $125 $_______
❑ CDC/ATSDR Federal Employee no charge
ASA ID # (if known)
❑ Student (with valid ID) $75 $_______

Preferred Name for Badge
TOTAL FEES: $_______
Please be advised, participants will be provided a link to short course materials
Organization
and are expected to print these materials on their own prior to the symposium.
PAYMENT
Address
❑ Check/money order payable to the American Statistical Association (in U.S. dol-
lars on U.S. bank)

Credit Card ❑ VISA ❑ MasterCard ❑ American Express
City State/Province ZIP/Postal Code
Card Number
Country (non-U.S.) Exp. Date CVS# (3-digit # on back of card)
Phone Fax Name of Cardholder
Email
Authorizing Signature
❑ Check here if you would like your ASA customer contact
information updated with your meeting contact information.
CANCELLATION POLICY: All cancellations must be submitted in writing. Email:
mchevalier@amstat.org; Fax: (703) 684-2037; Mail: CDCSY Registration, c/o
American Statistical Association, 732 North Washington Street, Alexandria, VA
This meeting is ADA accessible.
22314. Cancellations received by 11:59 p.m., EDT, March 24, 2009, will incur a
❑ Please check here if you need special services
25% cancellation fee for each item cancelled. Cancellations received after March
due to a disability and attach a statement regarding your needs.
24, 2009, will not be refunded.
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