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2003 Annual
Spring Meeting
Registration Form
May 3-4, 2003
Hyatt Regency Bethesda
Bethesda, MD
Name: _____________________________________________________________________________________
(Title, First, Middle Initial, Last, Degree)
Department or Program Represented: _____________________________________________________________
Address: ___________________________________________________________________________________
__________________________________________________________________________________________
Phone: ____________________ FAX: ____________________ Email:
_________________________________
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[ ]
Registration Fee
(Includes registration and banquet dinner)
(For Saturday night banquet dinner: Vegetarian entrée
Yes/No)
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$
160.00
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Guest Fee @ $65.00 each
______________________________________________________________________
Guest Name(s) – (print or type)
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$____________
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Total
Check or Charge:
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$____________
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PAYMENT OPTIONS:
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[ ]
Check
(Make check payable to: ANDP or Association of
Neuroscience Departments and Programs.
US currency only. Drawn on US Bank.
Purchase Orders are not accepted as payment).
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[
] Credit Card
[ ] Visa
[ ] MasterCard
[ ] American Express
[ ] Discover
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Card#: ____________________________________________________
Expiration Date: ________/__________
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Cardholder’s Name:
________________________________________________________________________
(print or type)
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Cardholder’s Signature:
_____________________________________________________________________
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PLEASE RETURN THIS FORM AND PAYMENT BY: April
14, 2003
Association of Neuroscience Departments and Programs (ANDP)
41218 Roundup Road
Magnolia, Texas 77354
(281) 259-6737 [PHONE] (281) 356-2837 [FAX]
**************
Please make your own reservations at the Hyatt Regency Bethesda by April
2, 2003.
Call (301) 657-1234. Ask for ANDP rates.
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