Spotlight on GHB Conference Registration Form

How to register

1. You may register on-line at www.projectghb.org

OR...

2. Print and fax to: 801-382-4472
Mail payment to address at right--->
Print: DOC or PDF

OR...

3. Print and mail with payment to:
Project GHB Conference

Project GHB Presents:

The International Conference on GHB & Other Chemical Drugs
September 25-27, 2004
Palace Station, Las Vegas, Nevada

Agency

Mailing Address

City/State/Zip

Day Phone - include area code Fax - include area code

Evening Phone - include area code

Email Address Confirm Email:

Attendee(s):

First Name, Last Name [Yours] Title
First Name, Last Name Title
First Name, Last Name Title
First Name, Last Name Title
First Name, Last Name Title
First Name, Last Name Title

Which education track will you be taking?
(may attend classes, but we need to know primary interest)

Law enforcement, attorneys, judges, criminalists, & toxicologists
Medical (ER, rape treatment, research, coroners, addiction specialists)
School & Community Resources (including interested parents)

Attendance:

Three Days $150 - if registered before August 15, 2004
Three Days $190 - after August 15, 2004
Single Day Attendance

Additional Comments:

Credit Card orders will be able to pay immediately after pressing "Submit."

or click here:

* REMEMBER:

Hotel Information for the September 25-27

International GHB & Chemical Drug Conference in Las Vegas:

The Palace Station
2411 W SAHARA
Las Vegas, NV 89102

Call 800-634-3101 to make your reservations. Tell them that you are with the GHB Conference. Shuttle service is available to and from the airport and to the Strip.

From Mccarran International Airport
Take I-215 West To I-15 North To Sahara Avenue *Exit 40* Turn Left, Hotel On The Left At The Corner Of Rancho Drive And Sahara Avenue.

From Utah
Take I-15 South To Sahara Avenue *Exit 40* Turn Right, Hotel Is On The Left At The Intersection Of Rancho Drive And Sahara Avenue.

From Los Angeles
Take I-15 North To Sahara Avenue *Exit 40* Turn Left,hotel Is On Left At The Intersection Of Ranch Drive And Sahara.

From Phoenix
Take I-515/Us93/95 North To I-15 South Interchange. Proceed On I-15 South Approximately 2 Miles, Exit Sahara Avenue *Exit 40* Turn Right, Hotel Is On The Left At The Intersection Of Rancho Drive And Sahara Avenue.

For more information on the hotel visit: www.palacestation.com. Conference room rate is $89 plus tax.