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Registration Form
I wish to attend the joint meeting of UUֱ Chromatography & Electrophoresis Group with ACB Southern Region on 13th March 2009.
I am a (please tick as applicable):
member of ACB scientific meeting cost 25 j
m e m b e r o f R S C s c i e n t i f i c m e e t i n g c o s t 2 5 j
p r e - r e g i s t r a t i o n t r a i n e e C l i n i c a l S c i e n t i s t s c i e n t i f i c m e e t i n g c o s t 2 5 j
n o n - m e m b e r o f A C B / R S C s c i e n t i f i c m e e t i n g c o s t 5 0 j
f u l l - t i m e s t u d e n t / r e t i r e d m e m b e r s c i e n t i f i c m e e t i n g c o s t 1 0 j
I w i s h t o a t t e n d t h e R e c e p t i o n a n d D i n n e r f o l l o w i n g t h e m e e t i n g , a t
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N a m e ( p l e a s e p r i n t ) :
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..............
ACB/UUֱ membership number ..
Trust/Organisation: ..........................................................................................................................
Address: ..........................................................................................................................................
..........................................................................................................................................................
Email: ................................................................................ Telephone: .........................................
Signature: ........................................................................................................................................
Special Dietary Requirements: .......................................................................................................
Cheques are required with this registration form, made payable to: : ; M N c
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Please send registration form and cheque to :-
Dr Graham Mills
School of Pharmacy and Biomedical Sciences
University of Portsmouth
St Michael's Building
White Swan Road
Portsmouth, PO1 2DT. E-mail: HYPERLINK "mailto:graham.mills@port.ac.uk" \o "Email Graham Mills" graham.mills@port.ac.uk
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