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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