REGISTRATION FORM

9th Annual International Bioethics Forum:

Taking the Measure of the Magic Mirror

April 27-28, 2011
BioPharmaceutical Technology Center, Madison, WI

Name 
Address
City
State
ZIP/Postal Code
Country
Phone
Fax
E-mail
Profession
No Dinner
Add Dinner 		Optional Thursday Night
Dinner with a Speaker ($45)

The registration fee is $165 or $210 with optional dinner.

NOTE: After submitting your registration form you will be provided the option to pay online.

    

Checks made payable to "BTC Institute" should be sent to BTC Institute, 5445 East Cheryl Parkway, Madison, WI 53711. 

The BTC Institute will share your contact information with event sponsors, if so requested, unless you specifically advise us (BTC Institute) to keep that information confidential.