Great Lakes International Imaging and Flow Cytometry Association

1996 Membership & Meeting Application Form 



Name_____________________________________________________________________


Position_________________________________________________________________


Department_______________________________________________________________


Institution______________________________________________________________


Street Address___________________________________________________________


City, State Zip_________________________________________________________


Telephone______________________________ Fax______________________________


Email____________________________________________________________________


Birthdate_____________________________ Sex: Male___ Female___ 


Degree(s): MD___  PhD___  DVM___  MBBS___ BS____ Assoc. Degree____
        
Other: __________________________________________________________________





For the 1996 Meeting:

______ I will attend the Banquet Sat. Evening (Free for registrants)


______ I will bring a guest to the banquet. I enclose $25 US for each guest.


______ I enclose $65 US to register for the meeting (Includes Membership) no credit cards.

Fee at meeting willbe $80.00 US. Make Checks payable to GLI2FCA and send to address below.


______ To qualify for a travel stipend ($75) you must submit an abstract, a statement of need,
bring a poster to the meeting and be a _____Tech., _____master's student, _____pre-doc,
 or _____ a post doc.One stipend per laboratory.

ALL submissions will be judged for the $150 presidential award. We have
 decided to select these from all submitted abstracts for presentation at the Presidential Symposium.



 Hotel Reservation

You must fill out and mail this form for Hotel Reservations.



Abstract

Your abstract should fit in a box approximately 3 and 3/4" x 5" and use bold 12 point times font.


ABSTRACT DEADLINE is September 15, 1996


You can FAX (716) 845 8806


You can email abstracts to:stewart@sc3101.med.buffalo.edu 
stewart@sc3101.med.buffalo.edu 




Submit one copy of this application form to:


        Great Lakes International Imaging and Flow Cytometry Association
        Laboratory of Flow Cytometry
	Rosewell Park Cancer Institute
	Elm & Carleton Streets
	Buffalo, New York,  14263

         


MAILING ADDRESS (If different from above)


Street___________________________________________________________________


City, State Zip_________________________________________________________


Additional information call (716) 845-4579 or fax (716) 845-8806