ACMEGS: Registration Form

Name:
Affiliation:
Address:
City:
State:
Country:
Zip:
Email:
Phone:
Fax:

Date

November 6-7, 2008

Course Fees

$100
You must be an ACMEGS member to attend but can join prior to the conference or at the door.
This fee includes breakfast and lunch on both days, and dinner on 11/6.

Make checks payable to: ACMEGS, Inc

Mail checks to:

Stacey Ladieu
Athinoula A. Martinos Center for Biomedical Imaging
149 Thirteenth Street - Room 2301
Charlestown, MA 02129

Please be sure the NAME OF PARTICIPANT is included with the check.

Biosketch

Questions? Contact: sladieu@nmr.mgh.harvard.edu or call 617-724-7507

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