DIMACS Workshop Registration Form

Tutorial on Phylogenetic Trees and Rapidly Evolving Pathogens

June 19 - 20, 2006

Please register by filling out the following blanks.

When finished and you have checked the correctness of information, press the "send" button at the bottom of the form.

Attendance is limited to available space; please register early.


  Dates you plan to Attend: 
Your First Name: Your Middle Name: Your last Name:
Your Position: (Please select best choice with button.)
Your Postal Address: (This information will be used for nametags & mailing lists) Name of organization: (University or Company Name)
Organization Type: (Please select best choice with button.) Department: Street Address: City, State, Zip Code: Country:
Phone: Fax: E-Mail: Web page URL:
Comments: (i.e. dietary restrictions)

NOTICE: The usual fee waivers for DIMACS partners and affiliates DO NOT apply to this tutorial. Please click here to see applicable fees.

You must send in the registration fee deposit to ensure your seat at the tutorial.

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