Plant & Animal Genome XVII
Fax Registration Form

Complete this form online then print and fax to 201-653-5705.

Scherago International, 525 Washington Blvd, Ste 3310, Jersey City, NJ 07310

For university, non-profit and Government participants the fee will be:
$550 advance registration, postmarked/faxed by 1 November 2008 / $650 after 1 November 2008 / $750 On-site in San Diego

For industry participants the fee will be:
$750 advance registration, postmarked/faxed by 1 November 2008 / $850 after 1 November 2008 / $950 On-site in San Diego

For students (Pre-Ph.D - Requires a letter of certification from your dept. chairperson) the subsidized fee will be:
$350 advance registration, postmarked/faxed by 1 November 2008 / $400 after 1 November 2008 / $450 On-site in San Diego

For the weekand rate - Univ/Non-Profit/Government (Fri, Sat & Sun only), the subsidized fee will be:
$375 advance registration, postmarked/faxed by 1 November 2008 / $425 after 1 November 2008 / $475 On-site in San Diego

For the weekand rate - Industry (Fri, Sat & Sun only), the subsidized fee will be:
$475 advance registration, postmarked/faxed by 1 November 2008 / $525 after 1 November 2008 / $575 On-site in San Diego

Have you ever attended a PAG conference (Circle one): Yes ------- No

Full Name (e.g. Mr. Darrin Scherago):
Company / University / Affiliation:
Address:
City, State:
Postal / Zip Code:
Country:
Telephone Number: (Include Country Code):
Fax Number: (Include Country Code)
E-mail Address:
Credit Card: (VISA / MC) No American Express or Discover
Credit Card Type: (Debit / Credit)
Credit Card Number: (1234-5678-9012-3456)
Expiration Date: (MM/YY) Must be Current.
Amount:
Main Interest: (Plant / Animal)