P I M M S
2002 - 2003
BIOTECHNOLOGY  INSTITUTES

REGISTRATION FORM

Please check one:
______ $90 for one session

______

 $85 for each of two or more sessions

______

 $85 per person per session for two
or more registrations from the same school or district
Check Institutes you plan to attend:
______ Biotechnology on a Shoestring
January  17, 2003
 Registration Deadline:  January 3

______

 Biotechnology Update: Bioethics
March 18 , 2003
 Registration Deadline:  March 4

Please print

Name________________________________________ e-mail __________________________

School______________________________________ District__________________________

School Address________________________________________________________________ 

City____________________________  State______ Zip________ Phone__________________

Home Address________________________________________________________________ 

City___________________________  State______ Zip________ Phone__________________ 

I request CEUs   ( )Yes  ( )No.   If Yes, SSN is required _________________________________

In order to reserve a space in the workshop of your choice, fax or mail registration form immediately. Checks (payable to PIMMS) must be received before session begins. No refunds for non-attendance without notification prior to workshop. Please retain a copy of this registration form for your records. 

You will receive an e-mail message confirming your registration. In addition, directions and an agenda will be sent to you one week prior to each session. (This will serve as your registration confirmation if you do not have e-mail). If you do not receive confirmation, call the PIMMS office or e-mail Wilma Toney at wtoney@wesleyan.edu.

Biotechnology Institutes
PIMMS - Wesleyan University
178 Cross Street
Middletown, CT 06459-0200
860-685-6457/Fax: 860-685-6461