Exon-Intron Workshop Registration Form
        

Exon-Intron Workshop Registration Form

Please fill out this form and submit it electronically. For extra security, FAX the completed form to 717-771-4062.

If you wish to pay by check, please fill out the form, print it, and mail with tuition check to Exon-Intron's address listed below.

or.. If you wish to pay by credit card, please enter credit card information on this form or, for extra security, FAX the completed form to 717-771-4062. American Express, Visa, Mastercard, and Discover cards may be used to register for the Peninsula College workshops. For all other courses, we can only accept American Express.

or.. Provide billing information under "Special Instructions."

Name:
Email:
Title:
Company or
Organization:
Address:
City:
State/Province:
Zip/Postal code:
Country:
Tel:
Please include telephone area code and country code if needed.
Fax:

CHECK BOX TO CHOOSE CLASS OR CLASSES
Course Date Location Price
US$ per person		 Check

PCR Methodology

August 6 - 10, 2007

Peninsula College; Port Angeles, WA

$1250.00

Advanced PCR Techniques

August 13 - 17, 2007

Peninsula College, Port Angeles, WA

$1250.00


Credit card information

Credit Card Information. See above for other payment options.

Name as it appears on credit card:

Credit card number:

Expiration date as it appears on credit card:

Any special instructions? If you are registering more than one person, please tell us how many total people you are registering and enter their name or names here.

Notification of Training Cancellation Policies:
Tuition is refundable up to 30 days prior to the first day of the workshop; please note that cancellations are subject to a $100 administrative fee. A receipt and confirmation of registration will be issued when this form and tuition are received. Exon-Intron reserves the right to cancel any workshop, without penalty, up to 30 days prior to the first day of the workshop. In the unlikely event of such a cancellation, a full refund of any tuition received will be returned to each participant.

THIS IS NOT A SECURE SITE. THE CONTENTS OF THIS FORM WILL NOT BE ENCRYPTED. IF YOU DO NOT WISH TO SUBMIT THIS FORM ELECTRONICALLY, PLEASE PRINT, AND THEN POST OR FAX THE FORM TO:

Exon-Intron, Inc.
WORKSHOP COORDINATOR
P.O. Box 395
Loganville, PA 17342
Tel: 717-428-3780
Tel: 800-407-6546 Toll Free US & Canada
Fax: 717-771-4062
workshop@DNAtech.com


Registration forms must be accompanied by full tuition (US funds only). Tuition can also be paid by credit card.

Questions? Contact us by telephone at +1 717-428-3780 (800-407-6546 toll free North America) or via email: workshop@DNAtech.com

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