|
Credit
Card Payment Form |
|
|
Name
on Card |
_____________________________________________ |
|
Type
of Card |
_____________________________________________ |
|
Credit
Card # |
_____________________________________________ |
|
Expiration
Date |
_____________________________________________ |
|
Amount
to be Charged to Card |
_____________________________________________ |
|
Signature |
_____________________________________________ |
Registration fee is $35, $60
for symposium and dinner. A $10 late
registration fee is applied if not received by the deadline date of May 1, 2009.
Please mail your payment information along with your completed registration
form to:
Susan Burkard
University at Buffalo
Department of
Microbiology & Immunology
243 Biomedical Research
Building
Buffalo, NY 14214
OR
Fax to: Susan Burkard
716-829-3534