March 26-27, 2004
Surname ________________________ Given name & initial________________________
Address ____________________________ City\Town ____________________________
Prov./State ___________________ Postal/Zip Code ___________________________
Telephone (______)______-_________
E-mail __________________________ Name for Badge _______________________
Fee Calculator
1. Registration
Before March 5, 2004 ($30.00) $__________
After March 5, 2004 and at the door($35.00) $__________
2. Meals
Boxed Lunch (must be ordered by March 5) ($6.50) $__________
3. Banquet
Tickets must be ordered by March 5 ($32.00) $__________
Total Enclosed
$__________
Please make cheque or money order payable to:
Send cheque or money order along with completed registration form to:
GENE-O-RAMA
c/o 20 Glacier Street
Ottawa, ON K2J 2N1