23996

Conference Registration Form

First Name:
Last Name:
Organization
or Name of School:
Street Address:
City:
 State: Zip:
Day Phone:
 Fax:
Email:
Lunch:
 Vegetarian
Notes
Fee Schedule: Fee:
Student Registration: $20.00
Early Registration: postmarked by June 13, 2008 (includes 2 lunches, reception and all breaks) $50.00
Late Registration: postmarked after 6/13/2008 $75.00
Total Fees Paid:
 $
If credit card order credit card holder name:

UCB Tax ID 94-6002123
No refunds after June 13

(if you don't proceed to the next page, contact Sherry Cooper, 530-224-4902)