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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 27th,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-SkillingTM Canada 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
 No