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Association of Neuroscience Departments and Programs
2007 Annual
Fall Meeting
November 3, 2007
5:30 p.m. until 7:30 p.m.
San Diego Marriott Hotel and Marina
Manchester 1 and 2
San Diego California
Registration Form
Name: _______________________________________________________________________________
(Title, First, Middle Initial, Last, Degree)
Department or Program Represented: __________________________________________________
University or Institution: _______________________________________________________________
Address: _____________________________________________________________________________
_____________________________________________________________________________________
Phone: __________________ FAX: __________________ Email:
_______________________________
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[ ]
Registration Fee
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$
30.00 |
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] Guest Fee @ $30.00 each |
$________ |
Guest Name(s) – (print or
type) _________________________________________ |
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Total |
$________ |
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PAYMENT OPTIONS:
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[
] Check
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(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: ____________________________________________________________ |
Billing Address:
___________________________________________________________________
__________________________________________________________________________________
Cardholder's Phone:
_____________________________
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DEADLINE FOR RECEIPT OF REGISTRATION AND
PAYMENT: October 19, 2007
Association of Neuroscience Departments and Programs (ANDP)
41218 Roundup Road
Magnolia, Texas 77354
(281) 259-6737 (PHONE) (281)
356-2837 (FAX)
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