Proteomics: Fundamentals and Technology Platform

August 17 – 21, 2009

ADVANCE REGISTRATION FORM

Three Ways to Register
Register On-Line
http://conferences.ucdavis.edu/proteomics
Credit Card Payments/Campus Recharge Only
Register by Mail
Mail completed form and payment to:
Conference & Event Services
Attn: Proteomics
University of California, Davis
One Shields Avenue
442 Memorial Union
Davis, CA 95616

CANCELLATION POLICY

Refunds for cancellations must be received in writing by Friday, August 14, 2009 and will be charged a $25.00 administrative fee. There will be no refunds for cancellations made after this date.
Refunds will be made after the conference and typically take 2-4 weeks to process. For questions please call 530.752.0198 or email to
Registration
Confirmation: Once your registration form has been processed, you will receive confirmation by email. 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. / (One registration form per attendee. Please print legibly or type)
Name:
Last / First / MI
Address:
Street Address
City / State / Zip Code
Phone: / Fax:
Please include area code / Please include area code
Email:
For confirmation purposes
UC Affiliate: Grad Student_____ Post Doc_____ Faculty _____ Tech Staff _____ Non UC _____

Registration Fee Information (Registration Fees are per person)

Lecture and Lab are limited to 30 participants. Course will be filled on a first-come, first-served basis.

UCD – DEB Grad Students / $850 / $
UCD Academic/Clinical / $900 / $
UC Academic/Clinical / $950 / $
Non-UC Affiliate / $1,000 / $
Industry / $1100 / $
Lecture Only is limited to 30 participants. Course will be filled on a first-come, first-served basis.
UCD – DEB Grad Students / $300 / $
UCD Academic/Clinical / $350 / $
UC Academic/Clinical / $400 / $
Non-UC Affiliate / $450 / $
Industry / $550
Total: / $
Payment Information
Enclosed is my check/money order made payable to "UC Regents"
VISA / MasterCard / American Express / Discover
Credit Card Number / Expiration Date
Name as it appears on card / Signature
I will be paying by UC Davis Recharge (all sections must be completed)
Full Dafis Number: / Sub Account:
Department:
Account Manager: / Phone Number: