International Clearinghouse for Birth Defect Monitoring ...
National Birth Defects Prevention Network 9th Annual Meeting
January 30-February 1, 2006
Marriott Gateway Crystal City
Arlington, VA
REGISTRATION FORM
The registration deadline is January 4, 2006. The registration fee is $150 for the meeting; GIS Hands-on training is an additional $50.00. Please make the check payable to NBDPN.
Contact Information
Name: Degree(s):
Title:
Organization/Affiliation:
Address:
City: State: Zip: ___________
Phone: Fax:
E-mail:
( Lunch (no additional cost for lunch on Wednesday)
Wednesday, February 1, 2006
( Yes, I plan to attend.
Individual box lunches, please select one: __ Smoked Turkey __ Roast Beef __ Vegetarian Wrap
Smoked Turkey: Smoked turkey with provolone, Dijon mustard, served on multi-grain whole wheat bread; vegetable chips, whole fruit, oatmeal raisin cookie
Roast Beef: Sliced roast beef with aged cheddar, horseradish cream, served on sourdough baguette; barbecue chips; whole fruit; chocolate chip cookie
Vegetarian Wrap: Marinated julienne vegetables, basil spread, mixed greens and Feta cheese, wrapped in a spinach flour tortilla; vegetable chips; whole fruit; oatmeal raisin cookie
( No, I do not plan to attend.
Hands-on Training Seminar: GIS Applications in Birth Defects Surveillance and Research
( Yes, I’m interested in attending the GIS training seminar on Sunday, January 29, 2006.
Note: Basic knowledge of ArcView is required. The registration fee for this training is $50.00.
( Computer demonstrations and education materials/resources
( Check this box if you plan to present a computer demonstration or will be bringing educational materials/resources. Note: You do not need to check this box if you are only participating in the poster session.
New to NBDPN
( Check this box if this is your first NBDPN annual meeting or if you are a new NBDPN member.
Comments
(
Return this form along with your registration fee of $150.00 to:
National Birth Defects Prevention Network (NBDPN)
14781 Memorial Dr.
Number 1561
Houston, TX 77079
Phone: (404) 498-3918 Fax: (404) 498-3040
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