Fifth Workshop on Biosensors and Biological Techniques in Environmental Analysis Registration Form

Payments must be made in US Dollars
Payment methods: Check, payable to Cornell University-Biosensor Conference
                                  Credit Card (see below)
                                  Wire transfer, contact Prof. Baeumner at ajb23@cornell.edu

For registration, complete this form and mail with payment to:

Cornell University, Biosensor Conference, P.O. Box 922, Ithaca, NY 14851

Name:_________________________________Title:________________________________

Organization:________________________________________________________________

Mailing Address:_____________________________________________________________

City:________________________State/Province:________________Zip Code:____________

Country:______________________________


Phone:_________________________________Fax:__________________________________

E-mail:______________________________________________________________________


Registration fee:$_________________*
              *Students must include a copy of their ID card together with the registration
              form to be eligible for the reduced rate registration fee.

If you choose to pay by credit card, please fill out the information below:

_____Visa       _____Mastercard       _____Discover       _____American Express

Credit Card Number:__________________________________________Exp. Date:__________


Signature________________________________________________________