Home > Programs > Technical > Biophotonics > Biology for Biophotonics > Registration Form
Technical
Graphical Version
Biophotonics

Vitesse Interdisciplinary Workshop
Biology for Biophotonics
February 22 - 25, 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 (Work)
#11  Telephone (Home)
#12  Fax
#13  E-mail
COURSE FEE
#14  Registration Fee
(Note: Early Bird Discount ends February 10th,2005)
PAYMENT INFORMATION
#15  Payment Method

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.
1200 Montreal Road, Building M-50, IPF
Ottawa, ON K1A 0R6
Attn: Annalisa Garbe

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

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