| REGISTRATION |
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| You
can register for the conference, make hotel reservations
or submit an abstract by mailing in |
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| or
faxing the form below. |
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| Please
return to: |
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| EICOSANOID
CONFERENCE ORGANIZING COMMITTEE |
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| Ms.
Celeste Riley |
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| Department
of Biochemistry |
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| Vanderbilt
University School of Medicine |
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| Nashville,
TN 37232-0146 |
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| USA |
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| A.
PARTICIPANTS (please type) |
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| ________________________________________ |
_________________________ |
________________________ |
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| Family
Name |
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First
Name |
Telephone |
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| ____________________________________________________ |
________________________ |
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| Affiliation
/ Institution |
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Fax |
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| ____________________________________________________ |
________________________ |
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| Street
Address |
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e-mail
address |
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| ____________________________________________________ |
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| City,
State, Province, Country, Postal Code |
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| B.
ACCOMPANYING PERSON(S) |
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| ________________________________________ |
__________________________ |
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| Last
Name |
First
Name |
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| ______________________________ |
__________________________ |
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| Last
Name |
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First
Name |
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| REGISTRATION
FEES (place "X" where applicable) |
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Before
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After
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Daily
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6/1/01
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6/1/01
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| Ph.D.
/ M.D. |
$425.00
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$500.00
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$300.00
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| Post-Doc
Students* |
$275.00
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$325.00
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$150.00
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| Graduate
Students* |
$200.00
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$250.00
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$100.00
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| Banquet |
$25.00
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$25.00
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| *students
must include a letter from their advisor verifying their status |
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| METHOD
OF PAYMENT |
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Check (personal
or institutional) made to Vanderbilt University-Eicosanoids OR Institutional
purchase order (hard copy must accompany registration) made out to
Vanderbilt University-Eicosanoids. |
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| We
apologize, but credit card payments cannot be accepted. |
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