The 17th Bruker-Nonius CCD Users Group Meeting

Madison, WI, May 31-June 2, 2009

Registration Form

Note: Each workshop will be held three times. List your workshop selections in the order of preference. The number of participants in each workshop is limited.

Title (Dr., Professor, etc): _______________________________________

Name: ______________________________________________________

Position: _____________________________________________________

Street Address: _______________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

Telephone: (_______)___________________

Fax: (_______)________________________

E-mail: ______________________________________________________

Web page:___________________________________________________

Choice of workshops (List workshop titles in the order of preference).

1____________________________________________________________

2____________________________________________________________

3____________________________________________________________

Registration fee is $70 (includes the reception dinner and two lunches). Amount enclosed: ___________

Make checks payable to the Chemistry Department, UW-Madison, attn. Ilia Guzei.

Mail to:

Ilia A. Guzei, Ph.D.
2124 Chemistry Department
University of Wisconsin-Madison
1101 University Ave
Madison, WI 53706 USA