The American Infertility Association presents:
"Infertility and Adoption Conference 2000"
Grand Hyatt Hotel (Park Avenue at 42nd Street - Grand Central Station ), New York City
Sunday, March 5th, 2000          7:30 AM to 5:30 PM
Registration Form

Non-members can attend the symposium and join The American Infertility Association for a reduced rate. For a combined fee of $85.00 per person or $120.00 per couple, you can join The American Infertility Association ($45.00) and gain admission to the symposium.)

Admission includes continental breakfast, coffee breaks, registration materials and entrance to all workshops and the exhibit hall. Payment may be made by check, AmEx, MasterCard, or VISA. Seating is limited.  Please note that walk-in registrations on the day of the event are welcome as space allows.

Name ______________________________________________________

Address            _____________________________________________________
                        _____________________________________________________
City, State, Zip  _____________________________________________________

Telephone ____________________________ (required for credit card orders)

Today's Date: ____________________

Number of attendees: _______     Total amount of payment: ______________

Form of payment:   [   ] Check         [    ] AmEx        [    ] VISA     [     ] MasterCard

Credit Card #: _______________________________________________
Expiration Date: ______________________________________________
Signature: __________________________________________________

Please make checks payable to:
The American Infertility Association

Mail completed form (must be received by March 3, 2000) to:
     The American Infertility Association
    
     New York, NY 10103

Or fax the completed form (credit card only) to .  You may also register by telephone (credit card only) by calling , between the hours of 9:00 am and 5:00 pm.  We regret that registration fees cannot be refunded.