2nd Bruce Ames International Nutritional Genomics Conference

University of California, Davis

October 12-14, 2007


Three Ways to Register
Register On-Line
Credit Card Payments Only
Register by FAX
Complete this form and FAX to (530) 752-5791
Credit Card Payments Only
Register by Mail
Mail completed form & payment to:
Conference & Event Services
Attn: Nurtigenomics
University of California
One Shields Avenue
442 Memorial Union
Davis, CA 95616
Cancellation Policy
All cancellation must be received in writing no later than Friday, September 28, 2007. Cancellations received after this date will not be processed. Cancellations received prior to this date and time are usually processed after the conclusion of the conference and will be refunded minus a $40 administrative processing fee.
Mail/Fax cancellation to:
Conference & Event Services
Attn: Nutrigenomics
University of California
One Shields Avenue
442 Memorial Union
Davis, Ca 95616
Fax: (530) 752-5791
Please note:
Conference & Event Services
does not accept Purchase Orders, nor do we issue invoices for conference registrations. / Name and affiliation will appear on name badge. Print legibly or type. One form per registrant.
First Name / Last Name / MI
Street Address
City / State / Zip Code / Country
Phone: / () / Fax: / ()
Please include area, city and country codes / Please include area, city and country codes
Required for confirmation purposes and receipt.
Registration Information
This discount is 50% offthe Pre-Symposium and Symposium Feesas well as the Banquet and Reception.This discountis restricted to residents of Yolo, Solano and Sacramento Counties, 55 years of age or older and not affiliated with the University of California, Davis
Last day to register for the conference is Friday, October 5, 2007

Registration Fee Per Person

/ By July 15 / Jul 16 – Oct 1 / After Oct 1 / Totals

Symposium: Sat/Sun, Oct. 13 & 14

Senior Discount: Symposium Registration / $20 / $25 / $27.50 / $
Workshop: Fri, Oct. 12
Senior Discount: Pre-Symposium Workshop / $20 / $23 / $26.50 / $
Senior Discount: Evening Reception (Friday-10/12) / $15 / $15 / $20 / $
Senior Discount: Symposium Banquet (Saturday-10/13) / $25 / $27.50 / $30 / $
Napa Wine Tour (Sunday-10/14) / $80 / $90 / $100 / $
Symposium T-shirts / $30 x ____ / $
Please indicate t-shirt size: Small Medium Large
Symposium Banquet Meal Choices: Chicken Fish Vegetarian
Total / $
Conference Questions
Please list any special needs (i.e. food allergies, vegetarian etc.)
Payment Information

Enclosed is my check/money order made payable to "UC Regents"

Please charge my: / VISA / MasterCard / American Express / Discover
Credit Card Number / Expiration Date
Name of Card Holder (as it appears on card) / *Signature of Card Holder
*Registration Form will not be processed without the signature of the cardholder.

Registration Confirmation: Once your registration form has been processed, you will receive confirmation by email. This confirmation will include an official University receipt (receipts will not be handed out on-site at the conference). If you have not received an email confirmation ten business days after submitting your registration form, please contact Conference & Event Services at (530) 752-0198 or to inquire on whether your registration form was received.