Biosafety
and Biosecurity Training Course Registration Form
2008 BIOSAFETY and BIOSECURITY TRAINING COURSE - July 9-16
Please e-mail or fax this completed form to Dr. Robert
P. Ellis
robert.ellis@colostate.edu, Fax: 970-491-4804
MasterCard, VISA, American Express, and Discover Credit
Cards are accepted.
Registration and Payment Form
Please type or print the following information:Name:__________________________________________________________
Affiliation:_______________________________________________________
Department:_______________________________________________________
Address:________________________________________________________
City:________________________State:_______Zip/Country:______________
Phone:______________________________Fax:________________________
E-mail:(type or print)_____________________________________________________
Method of Payment: (select one) check________ credit card________
REFUND POLICYPayment by check: Checks should be made out to "Biosafety and Biosecurity Course". Send payment to:
Dr. Bob Ellis
141E General Services Building, Campus Delivery 6021
Colorado State University
Fort Collins, CO 80523-6021
Payment by credit card: (Please fill in the following information)
Credit Card Number: ________________________________________
Expiration Date: __________
Verification No.(This is the 3 digit number - it may
follow a 4 digit number- which appears on the signature strip on the back
of the card): ______
Name on the card: _______________________________________
Street Address: _________________________________________
Zip/Country Code: _______________
Type of credit card (Visa, MasterCard, American Express, and Discover Card): _______________
What are you paying? Please check one of the following options:
a) Animal + General Sessions ($1300)
b) Plant + General Sessions ($1300) ________
c) Animal + General + Plant Sessions ($1600)
Amount you are paying: _______________
REFUND POLICY: Registration fee full refund, less $20, if requested within 35 days of annual meeting; 50% refund from 34 - 15 days before annual meeting; no refund if requested 14 days or less before annual meeting.