18th Annual Symposium on Industrial and Fermentation Microbiology

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Print out the form below or download the .pdf file. Fill it out and send with your check to the address below.


Eighteenth Annual Symposium on Industrial and Fermentation Microbiology

Friday, April 25, 2014
Radisson Center
La Crosse, Wisconsin

REGISTRATION

Please Print

Name_________________________________________________________________________________

Title_________________________________________________________________________________

Organization__________________________________________________________________________

Address______________________________________________________________________________

City_________________________________________________________________________________

State__________________________________________________ Zip code ______________________

E-mail_______________________________________________________________________________

Certification is required to register as a student

____________________________________________________________________________________
Faculty Signature

_____________________________________________________________________________________
Printed or Typed Faculty Name

_____ Check if you plan to attend the Alumni and Friends Reception on Friday, April 25, 2014.

Registration fee includes Symposium Proceedings, Coffee Breaks and Lunch

Conference Registration                       Check one

Before April 23, 2014                      $40 __________

After April 23, 2014                        $45 __________

At the Door                                  $45 __________

Student                                       $10 __________

Guest/Spouse                               $15 __________

 

Make checks payable to: University of Wisconsin-La Crosse

Mail the registration form and check to

            S.N. Rajagopal, Ph.D.
            Department of Microbiology
            University of Wisconsin-La Crosse
            1725 State Street
            La Crosse, WI 54601