2017 NCRAR International Conference

 

Register here for the NCRAR Conference

Translating Tinnitus Research Findings into Clinical Practice 

 

                                           taking place in Portland, Oregon

                                           October 4-6, 2017

Your Information (as it will appear on your badge)
*First Name:
*Last Name:
Degree:
Institution:
State / Province:
*Email Address:
We report demographic data about conference attendees to NIH. Please provide the following information:
*What is your primary occupational role?:	AudiologistResearcherStudentOther
What is your ethnicity? (optional):	-please select-Hispanic or LatinoNot Hispanic or Latino
What is your race? (optional):	-please select-White, not of Hispanic origin American Indian or Alaska Native Asian, Native Hawaiian or Other Pacific Islander Black or African American
Payment Information
Note: Due to VA affiliation, government credit cards will not be accepted for payment.
*Description:	-please select-Federal Employee (VA/DOD/NIH)StudentOtherApproved Complimentary Registration
Total:	$
*Payment Type:	-please select-Credit Card (preferred)CheckApproved Complimentary Registration
Late registration: After 8/25/17, the conference price increases to $300 for all conference registrants.

Credit Card Type:	-please select-VisaMastercardDiscoverAmerican Express
Name on Card:
Credit Card Number:
CVV2 number (3 digit number on back of card):
Expiration Date (Month):	-please select-010203040506070809101112
Expiration Date (Year):	-please select-201120122013201420152016201720182019202020212022202320242025
	Note: Due to VA affiliation, government credit cards will not be accepted for payment.
Billing Address
(credit card) Street Address :
(credit card) City:
(credit card) State:
(credit card) Postal Code:
(credit card) Country:

Cancellation Policy
Credit card transaction costs are charged to the NCRAR, therefore the following cancellation policy will be in effect as of 6/1/17. Cancellations on or before 7/17/17 will be refunded at 80% of the registration fee. Cancellations between 7/18/17 and 8/31/17 will be refunded for 50% of the registration fee. No money will be refunded after 9/1/17 because conference deposits will already have been paid by this date.
Contact Us
Questions: NCRAR 503.220.8262, x57153 Email: NCRAR.Research@va.gov
	Note: All conference facilities are wheel-chair accessible. We will offer assistive technology; FM systems will be available at the conference. Please email us at NCRAR.Research@va.gov if you need assistance with childcare arrangements or have any other accommodation needs.

If paying by check, please send check to: Portland VA Research Foundation PO Box 69539 Portland, OR 97239

Anti-spam Captcha:
Fill in the text