CDISC Online Registration

ODM and SDTM Seminars
18-20, 25-27 July 2005
McLean, VA and South San Francisco, CA

Note: Please complete this form to register for ODM and SDTM Seminars.

Your total will be updated based on your membership category. When you are complete, click Submit Registration. Your total will be re-calculated and your registration submitted to CDISC for confirmation and to process your payment. See below for CDISC Privacy Information.

Note: Required fields are marked with an asterisk.

*Name:

First:

Middle:

Last:

*Job Title:

*Company:

If you are a CDISC member, please select your company name from this list:

If you are not a CDISC member or sponsor, please enter your company name:

Please check here if you are a CDISC corporate sponsor or benefactor, or if you are an academic, government, or non-profit organization

*Street Address or
P.O. Box Number:

*City:

*State / Province:

*Zip / Postal Code:

*Country:

*Phone Number:

*Fax Number:

*Email Address:

Emergency Contact:

Emergency Contact Phone Number:

Registration Costs
NOTE: If you take 2 seminars (i.e. both ODM and SDTM) then there is a discount for taking both. This discount only applies to the same person taking 2 seminars.
		CDISC Corporate Sponsor/Benefactor, Academic, Government, Non-Profit	CDISC Associate or Corporate Member	Non CDISC Members (full price)
Course: From Clinician to Submission
	Not Attending this course.
	Location: McLean, VA
	18 July 2005, 9:00 am to 17:00 pm 19 July 2005, 9:00 am to 12:00 pm	Registrations for this seminar are no longer being accepted. If you wish to attend this seminar, there is still availability in San Francisco.
	Location: South San Francisco, CA
	25 July 2005, 9:00 am to 17:00 pm 26 July 2005, 9:00 am to 12:00 pm	$375 (US)	$900 (US)	$1500 (US)

Course: Getting Comfortable with CDISC Data Submission Standard
	Not Attending this course.
	Location: McLean, VA
	19 July 2005 13:00 pm to 17:00 pm 20 July 2005 09:00 am to 17:00 pm	Registrations for this seminar are no longer being accepted. If you wish to attend this seminar, there is still availability in San Francisco.
	Location: South San Francisco, CA
	26 July 2005 13:00 pm to 17:00 pm 27 July 2005 09:00 am to 12:00 pm	$375 (US)	$900 (US)	$1500 (US)

TOTAL

Payment Method:	Credit Card
	Check (invoice will be submitted via e-mail)

Note: CDISC reserves the right to change the venue, if necessary. If an event is canceled, CDISC is not responsible for any airfare, hotel or other costs incurred by registrants. Speakers and program agenda are subject to change.

Note: You will receive a confirmation/receipt via e-mail with the total charges for your registration. If you encounter any problems using this online registration form or if you have any questions, contact Shirley Williams at swilliams@cdisc.org (tel. 512-341-9885).

CDISC Privacy Information

Note: All credit card information collected on the CDISC web site is done so using SSL (Secure Sockets Layer -- the industry standard security protocol), which encrypts your payment information. The information we collect from you when you make an order or register for a course is necessary to process your order, and it is only accessible to CDISC's Administrative staff.

In order to make sure that your order is being handled properly, CDISC may contact you by regular mail, phone or email for any of the following reasons:

To clarify your order or registration,
To clarify your shipping information,
To follow up on your order to determine and improve our services to you.