=======================================================================
The Plant Center Retreat Registration Form for UGA & Related Institutes
Evergreen Marriott Conference Resort, October 30 and 31, 2008
=======================================================================
Deadline for registration is Monday, 22 September 2008 at the latest.
Please type or neatly print the following:
-------------------------------------------------
Name: _________________________________________________________
Department: __________________________________________________
E-mail address: ________________________________________________
Male/Female: __________________________________________________
Social Security No. (last 4 digits required to attend):__________
Phone: _________________________ Fax: __________________________
Are you on UGA Payroll? _________________________________________
Smoking Room? Yes/No: __________________________________________
Hotel (rooms have 2 double beds)_________________________________
Roommate Preference: ____________________________________________
Will you be taking the UGA Bus? Yes/No: _________________________
Circle Status: Faculty Staff Postdoc Grad-Student Undergrad
A $75 registration fee is required to attend the retreat.
Method of payment to guarantee registration:
____ Personal Check payable to The Plant Center
____ Cash
____ UGA Check Request payable to The Plant Center (submitted by your department)
You may pay the registration fee by UGA Check Request through your department.
If you pay by personal check or cash your registration payments may be reimbursed
from your grant or other accounts, but we cannot direct charge accounts. We will
not be able to refund your registration fee if you cancel after October 3rd.
I plan to attend the The Plant Center Retreat.
Signature: _______________________
====================================================================================
Please return this form with registration fee to:
The Plant Center Phone: 706-542-1820
Attn: Carla Ingram Fax: 706-542-1805
Plant Biology Department
2502 Miller Plant Sciences Bldg.
University of Georgia
Athens, GA 30602-7271