Registration Form

CINT 6th User Workshop
January 9-10, 2008
Albuquerque, NM

*Denotes required field.

Prefix:
First Name:*
Last Name:*
Citizenship:*
Affiliation:*
Organization Name:*
Address1:*
Address2:
City:*
State:
Zipcode:*
Country:*
Phone:*
Fax:
Email:*

Research Interests:* (check all that apply)

Indicate plans to attend:* (check all that apply)

How will you be paying for your registration fee?*	check credit card

Are you a Postdoc or a Student?	yes no

Would you like to go on the CORE facility tour:*	yes no