Green Crop Network Workshop Registration Form

July 10th & 11th 2008

Salle du Parc, New Residence Hall, 3625 avenue du Parc, Montreal

Registration Form

Name
Organization
Address
City		Province
Postal Code
Phone		Fax
Project Code if applicable		Email
Affiliation	University (please check the appropriate box) Researcher Post-doctoral fellow M.Sc PhD Government Industry Other (please specify) Students and Post-doctoral fellows, please indicate the name of your supervisor (s) Dietary restrictions (if any) Registration: Spaces are limited. We will confirm registration via email.
Affiliation

Registration Fees

	Before May 30, 2008	After May 30, 2008
Member*	FREE	$50
Non Member	$200	$250

*Green Crop Network affiliated researchers, post-doctoral fellows and students

Payment of Registration fees

By cheque

To pay by cheque please print this form, write down your contact information and send it with your cheque. Cheques are to be made payable to "Green Crop Network" and sent to:

Green Crop Network
Department of Plant Science
Macdonald Campus, McGill University
Department of Plant Science
21,111 Lakeshore Rd
Ste-Anne-de-Bellevue
Quebec H9X 3V9
Canada

By Credit Card

Please print and fill out this form , and sign the appropriate section.

Please fax (514) 398-7897 (Attention to Green Crop Network) or mail us a signed copy of this form.