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REGISTRATION FORM FOR CREDIT CARD PAYMENTS ONLY
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

PLEASE COMPLETE ALL THE FOLLOWING INFORMATION so you can be assured advanced receipt of materials and additional course information.

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:
Company/Institution
Address:
Telephone:	FAX:
E-Mail:	Will be used to provide you with pre-course materials
IACUC Title/Affiliation:	(e.g. Chair, Scientific Member, Non-Scientific Member, Non-Affiliated or Community Member, Attending Veterinarian, Administrator/Coordinator. Other: Veterinary Technician, Compliance, Trainer, Investigator, etc.) Please do not write “member”.
Number of Years IACUC Experience:
Please be sure you have completed all of the above fields before continuing. NOTE: Registration and credit card payment is a two step process. Complete this form and click SUBMIT. After the form confirmation is displayed, press the Back Button to return to this site. Proceed with the credit card payment process. American Express, Discover, Master Charge and Visa are accepted. Your registration will not be finalized until both steps are completed. If you prefer to pay by check complete the Registration Form for check payment or

Registration Fees

Registration for the TWO-day program: IACUC 101 and IACUC 201 PLUS Registration: $450.00/person.

Registration for ONE of the two days: IACUC 101 or IACUC 201 PLUS: Registration: $295.00/person..

Cancellations submitted in writing prior to Tuesday, May 6, 2008, are necessary for reimbursement of the registration fee minus a $50.00 administration fee. Cancellations after May 6, 2008, will not be refunded.

If you have questions, contact Penny Ashwanden at
pashwand@fau.edu or (561) 297-2319.

Updated April 2008