Michigan Chapter

2000 PRE-REGISTRATION FORM

**Abstract deadline: April 21, 2000 (unless submitting for award competition -- see Award Competition Guidelines)**

NAME: ______________________________________________________

CAMPUS/WORK ADDRESS:  ____________________________________

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PHONE: ____________________  E-MAIL: _________________________

____ Check here if you would prefer a vegetarian meal at the May Conference

CHAPTER FEES AND REGISTRATION  (check one):

________  Regular ($35.00)    ________  Students ($15.00)

________  I do not plan to attend the meeting, but I would like to
  keep my membership active. ($10.00)

MAKE CHECKS PAYABLE TO:
Michigan Chapter Society for Neuroscience

Mail this form and your check to:
Brandi L. Soldo, Ph.D.
Neuroscience Therapeutics
Parke-Davis Pharmaceutical Research
2800 Plymouth Road
Ann Arbor, MI 48105

PHONE: (734) 622-1640 FAX: (734) 622-7178
E-Mail: Brandi.Soldo@wl.com

PLEASE BE SURE YOU HAVE MAILED ALL OF THE FOLLOWING MATERIALS:
______ Registration Form                    _______ Check                            _______ Abstract