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Bioinformatics

BIOINFORMATICS WORKSHOP
Microarray Analysis
July 7-8, 2005
Registration Form

PERSONAL DATA

#1 Title

#2 First Name

#3 Last Name

#4 Institution

#5 Position

#6 Address

#7 City

#8 Province

#9 Postal Code

#10 Telephone (Home)

#11 Telephone (Work)

#12 Fax

#13 Email Address

COURSE FEE

#14 Registration Fee
(Note: Early Bird Discount ends June 27^th,2005)

PAYMENT INFORMATION

#15 Method of Payment

Please choose a method of payment:

Cheque (made payable to: Vitesse Re-Skilling Canada Inc.)

Visa

MasterCard

Amex

Cheques can be mailed to the following:
Vitesse Re-Skilling^TMCanada Inc.
349 Terry Fox Drive, Floor 3
Kanata, ON K2K 2V6
Attn: Annalisa Garbe
T: 613.254.9880 ext. 221

Note: You will only be registered upon receipt of cheque.

If you are paying by credit card, you will be contacted by phone for credit card information.

ADDITIONAL INFORMATION

#16 Bioinformatics Background

To better gauge the experience of registrants in order to ensure the course suits your background, please attach a brief summary that describes your bioinformatics experience or level.

Parking

#17 Do you require parking at BCIT- Burnaby campus?

Yes