CCFFR & SCL 2006 – Calgary Email, Fax or Mail-in Registration Form

Email To: (as attachment) ccffr@ucalgary.ca FAX To: John R. Post (403) 289-9311

Mail To: John R. Post Biological Sciences University of Calgary Calgary, Alberta T2N 1N4

Personal Information

First Name:	Last Name:
Affiliation:
Address:
City:	Province:
Postal Code:	Email:

Registration : Fees include attendance at the symposium, welcoming reception on January 5, all coffee breaks and the banquet on January 6. [Guests are welcome at the banquet at an additional charge]

Early: By December 12 , 2005	Late: After December 12 , 2005
Regular^1        $160.00	Regular^1        $200.00
Student^2         $100.00	Student^2        $140.00

¹ Regular Registration includes a $20 surcharge for the Clemens/Rigler Travel Fund. (As agreed to at the 2005 CCFFR Business Meeting)

² Student Registration requires the following information:

Student ID # :

Accredited Institution:

Extra Banquet Tickets : Number Required @ $45 =

Total Registration Costs: $

Payment Information

VISA	MasterCard	AMEX	Cheque
Name on Credit Card:
Billing Address:
Card Number: - - -
Expiry Date:   /               Signature :