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NEURON 2011 Summer Course Registration Form

To register for the NEURON 2011 Summer Course, please fill out this form and send it to us. To complete registration, you must also pay the $1275 registration fee by Wednesday, June 1, 2011.

The registration fee may be paid by credit card, check, or money order. If you wish to pay by credit card, please contact Ted Carnevale ted dot carnevale at yale dot edu for further instructions.

Payments by check or money order should be made out to NEURON 2011 Summer Course and sent to:

NEURON 2011 Summer Course
c/o Ted Carnevale
Neurobiology Dept.
Yale University School of Medicine
PO Box 208001
New Haven, CT 06520-8001

For those who need a street address:
NEURON 2011 Summer Course
c/o Ted Carnevale
Neurobiology Dept.
Yale University School of Medicine
SHM C303
333 Cedar St.
New Haven, CT 06510
Be sure to use the PO Box address if you are sending your check by the US Postal Service; otherwise it will be delayed by 2 to 3 weeks! The street address is only for courier services such as FedEx and UPS.

If you need Yale's Federal ID Number for tax purposes, please send an email request to ted dot carnevale at yale dot edu or call 203-494-7381.

Registration is not complete until payment is received (and cleared, in case you paid by check or money order). For further information about registration deadlines and fees, see the Registration Information Page.

Name
First :
Middle :
Last :
Title
Undergraduate student
Graduate student
Postdoctoral fellow
Faculty or other
Address
Organization :
Mailing address :
City :
State or Province :
Country :
ZIP or Postal Code :
Phone :
FAX :
Email :
Dietary preferences
Check whichever of the following may apply, so we can inform the caterer of special dietary preferences. Please email ted dot carnevale at yale dot edu if you have other dietary requirements. We will try to meet your needs, but this may not be possible in every case.
Kosher
Vegetarian (ovo-lacto)
Vegan

to ted dot carnevale at yale dot edu

After submitting this form, you should receive a copy of the information you entered at the email address you specified above. If you do not receive a copy, you probably mistyped your email address and should try again because we need it to contact you.

Note: if you have problems submitting this form, just email the information directly to ted dot carnevale at yale dot edu, or give up on all this WWW stuff and just send me a hard copy, with check or money order, by snail mail or express carrier (see addresses above).

NEURON 2011 Summer Course