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REGISTRATION FORM APS Workshop on Opportunities in Biological Physics

March 12, 2006 Baltimore Convention Center Baltimore, Maryland Organized by APS Division of Biological Physics Please print all information.

First Name:

Last Name:

_____________________

____________________________

Institution: ______________________________________________________________

Mailing Address:

_________________________________________________________

City: _____________________________

State: _______ Zip Code:

_______________

Email:

Phone:

____________________________

_______________________________

Registration Fee: A conference fee is required for registration. $25 will be added for late registration. Payment may be made by Credit Card, Personal Check or Business Check.

Please make checks payable to the American Physical Society.

PAYMENT

  • Personal Check

  • Business/Institution Check

  • Credit Card

    • Amex

    • Mastercard

    • Visa

    • Diners Club

    • Discover

$25

Student

$50

Postdoc

$75

All other participants

FEES:

NOTE: On-site registration is CASH ONLY!

Complete this form and return it by February 20, 2006. Fax: 301-209-0865. Mailing Address: Biological Physics Workshop, Attn. Ken Cole, American Physical Society, One Physics Ellipse, College Park Maryland 20740.

Credit Card #:

__________________________

Signature:

_____________________________

Exp. Date:

____________________

TOTAL: $

____________________

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