Physician Assistance in Bringing About Death: Can Regulation Work?

REGISTRATION FORM

Name__________________________________________Name Tag____________________________

Position/title_____________________________________________________Degrees_____________

Organization________________________________________________________________________

Address____________________________________________________________________________

City_________________________________________ State___________ Zip___________________

Tel: ( )__________________ FAX ( )____________________e-mail_________________

Member of _____California State Bar OR ________________ State Bar #:______________________

Please register me at:

Regular Rate $85.00______

Student Rate $50.00______ (photocopy of student I.D.required)

I enclose a check payable to the University of Southern California for $____________

OR

please charge $__________ to my VISA or MASTERCARD:

CREDIT CARD INFORMATION: If paying by credit card and/or faxing registration to (213) 740-5502: I authorize the University of Southern California to charge my registration fees as noted above to my Visa or MasterCard account (no other credit cards will be accepted).

Account number: ___________________________________ Expiration date:__________________

Cardholder's name:_________________________________________________________________

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Mail completed form and payment to:

Pacific Center for Health Policy and Ethics, USC Law School, Los Angeles, California 90089-0071

HOTEL: A block of rooms is being held at the Crowne Plaza Hotel, 3540 S. Figueroa St., Los Angeles 90007, directly across the street from the University, at a reduced rate of $75.00 Single and $80.00 Double Occupancy plus 14% occupancy tax. Parking for registered guests is $5.50 per day. Contact the hotel directly at (213) 748-4141 or at (800) 244-7331(California) or (800) 872-1104 (National). When making reservations, please inform the hotel that you will be attending the "Pacific Center Conference" and refer to code 2-LAW. Space and rate only guaranteed until 22 Oct. 1997. Cancellations must be made 14 days prior to arrival date to avoid first night's room & tax fee.

PARKING is available in the lot at Jefferson Blvd. and Figueroa St. (entrance on Figueroa) for $3/day. A map will be included in your confirmation letter.

REFUND REQUESTS must be made by November 4 by calling (213) 740-2541; a written request must follow. There is a $25 administrative processing fee and refunds take 4-6 weeks to process. All refund requests must be accompanied by registrant's Social Security number or the organization's Federal I.D. number. No registration cancellations will be accepted after November 4.

INFORMATION

Please call (213) 740-2541 or fax (213) 740-5502, or e-mail to mmiller@law.usc.edu