Registration Form

Registration:

Wake Forest University
28th Annual Perspectives in Biology Symposium

November 9 & 10, 2012

(Registration Deadline November 5)

Featured Speakers

• Terry C. Hazen, University of Tennessee/Oak RidgeNational Laboratory, Governor’s Chair and Professor in the departments of Microbiology, Environmental Science and Engineering, and Earth Sciences

• Kiisa C. Nishikawa, Regents’ Professor, Department of Biological Sciences, Northern Arizona University

• Robert S. Bridges, Head, Neuroscience and Reproductive Biology Section, Dept. Biomedical Sciences, Tufts University – Cummings School of Veterinary Medicine.

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(Detach and return with check) 

NOTE: Any Registration Received After Monday Nov 5 will NOT be Guaranteed Meals           

Name________________________________________ (Include Spouse/Guest Name for Badge) 

Institution_____________________________________

Address________________________________________

Email Address___________________________________

Registration fee of $85.00 includes the Friday evening banquet and lunch on Saturday. Meals for a spouse or guest also are available.

Registration fee $85.00         _________

Spouse or guest:

Banquet and lunch $50.00          _________
Banquet only      $35.00          _________
Lunch only        $15.00          _________

(Checks payable to Wake Forest University)

Total enclosed                    _________

Remit registration form and payment to:
Dr. Ron Dimock 
Department of Biology
Wake Forest University
1834 Wake Forest Road
Winston-Salem, NC 27109