Registration Form

Monday, May 14, 2012
D’Angelo Center, Ballroom # 416
11:45 a.m. – 5 p.m.

Please register by April 30, 2012. Register early to reserve your space.
There is no registration fee.

Contact Information

Name:

Title:

Company/Affiliation:

Mailing Address:

City:

State:

Zip Code:

Phone:

ext:

Cell Phone:

E-mail:

My organization would like to donate:

Donation Payment Method

Please make all checks or money orders payable to St. John’s University and mail it to: Dr. Vijaya Korlipara, Director, Institute for Biotechnology, St. Albert Hall Room 301, 8000 Utopia Parkway, Queens, NY 11439