2009 J. F. Bunnett Lecture Registration Form

Bunnett Lecture

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Chemistry and Biochemistry
University of California
230 Physical Sciences Bldg.
Santa Cruz, CA 95064
Phone: (831) 459-4002
Fax: (831) 459-2935
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2009 J. F. Bunnett Lecture Registration Form

Please register separately for each person attending this event, including guests/partners/spouses/significant others.

Title
First Name*
Middle Initial
Last Name*
Institution*
Mailing Address*
City*
State/Province*
Zip/Postal Code*
Country*
Daytime Telephone*
Email*
Badge Name*

I will attend:

	Reception (4:00 p.m.)	Free
	Awards Ceremony and Lecture (5:00 p.m.)	Free
	Banquet (6:30 p.m.)	$30.00

	Would like the Vegetarian Dinner
	Am an Alumnus/Alumnae

Payment Information (please choose one)
(additional payment information will be given on the confirmation page)

I plan on mailing my payment to the department before the event.

I plan on paying when I arrive.

Lesley-Reid Harrison - Bunnett Lecture
Department of Chemistry and Biochemistry
UC Santa Cruz, 1156 High Street, PSB 230
Santa Cruz, CA 95064 or lesleyrh@ucsc.edu

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