First Name:
Last Name:
Title:
Department:
Institution:
Mailing Address:
City:
State:
Zip Code:
Country:
Telephone:
FAX:
e-mail:
Status (Registration Fee):
Box lunch is included in the registration fee.
Method of Payment:
If CUFS Number, Enter Here:
Checks should be made out to "University of Minnesota" and sent
to Ms. Kathleen Clinton, MMC 451 Mayo, 420 Delaware Street S.E.,
Minneapolis, MN 55455.
Box Lunch on Friday, April 25?
Yes
No
Dietary Restrictions, if any:
Poster Presentation?
Yes
No
If Yes, Title:
Name and Institution to Appear on Name-tag
Name:
Institution:
For additional information contact Ms. Kathleen Clinton:
612-625-8424 (voice); 612-625-9442 (FAX)
e-mail: clinton@compneuro.umn.edu
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