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REGISTRATION FORM REQUIRING INTERNAL CODE
Institutional Animal Care and Use Training (IACUC)
Florida Atlantic University, Division of Research

Tuesday & Wednesday, May 20-21, 2008
Day 1: 7:30 a.m. – 5:00 p.m.; Day 2: 7:00: a.m. – 3:30 p.m.
Delray Beach Marriott, Delray Beach, Florida

Required Internal Code

Select the program(s) you would like to attend:
IACUC 101 & IACUC 201 PLUS, Tuesday & Wednesday, May 20-21, 2008
IACUC 101 only, Tuesday, May 20, 2008
IACUC 201 PLUS only, Wednesday, May 21, 2008

Name:	(as you want it to appear on your certificate)
Specialty / Degree:
Campus Address:
Telephone:	FAX:
E-Mail:
IACUC Title/Affiliation:	(e.g. Chair, Scientific Member, Non-Scientific Member, Non-Affiliated or Community Member, Attending Veterinarian, Administrator/Coordinator, Veterinary Tech, Compliance, Trainer, Investigator, etc.) Please do not write “member”.
Number of Years IACUC Experience:
Please complete this form and press SUBMIT.
or

If you have questions, contact Penny Ashwanden at
pashwand@fau.edu or 7-2311.

January 2008