COURSE REGISTRATION FORM

Molecular Approaches to Neuroscience

June 7-11, 2010

Name 
Address
City
State
ZIP/Postal Code
Country
Phone
Fax
E-mail
 
Please indicate the appropriate participant category for your application:
Student: would enroll through BTCI, i.e. no UW credits (course fee: $900)
Company / other organization employee: would enroll through BTCI; i.e., no UW credits (course fee: $1,150)
University of Wisconsin-Madison student or special student: would enroll for UW-Madison credits (course fee: tuition paid to UW-Madison)