(Attendance is welcome without pre-registration, but advance notice of attendance and also prepayment is helpful to the organizers of this conference, wherever such is possible)

Radiation and Health in the Nuclear Heartland October 11 and 12, 2002 at UNC Asheville, Asheville NC

PREREGISTRATION FORM – please register now!

The only cost is lunch and snacks $20  ($10 for low-income / student; full scholarship available for medical students and residents courtesy of WNCPSR). If you bring your own, there is no conference fee, but please let us know you are coming by registering now. Thank you!

Number of people_________ contact phone:________________

Additional phone numbers______________________________

Names:________________________________________________________________________________________________ Address_____________________________________________

City__________________________State_____Zip__________

e-mail________________________ website________________

 

Yes include me on a participant roster_____ OR no don’t_____

Yes I/we want lunch_______ how many total?__________

how many vegetarian?___________ how many meat?________

Total enclosed:_________________ ($20 each/$10 low income)

I need information on accommodations________ best way and time to reach me is____________________________________

 

? Questions ? – call Mary Fox Olson 828-675-1792

Snail Mail this form and your check made out to “NIRS” to

PO BOX 7586 Asheville, NC 28802  Thank You!