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Summary: The Plant Center Retreat Registration Form for UGA & Related Institutes
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October 28-29, 2010
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Deadline for registration is Tuesday, 19 October 2010 at the latest.
Please type or neatly print the following:
We apologize that our room block is totally filled, so we cannot accept any more
registrations for the retreat. As an alternative, we are offering a day registration for
Friday.
Name: ___________________________________________________________
Department: ______________________________________________________
Male/Female: _____________________________________________________
E-mail address: ____________________________________________________
Work Phone: ___________________________
Fax: _______________________
Are you on UGA Payroll?
Yes - _____________last 4 digits of social security number (required to attend)
No - __________________ 9 digit social security number (required to attend)
Check Status: Faculty Staff Postdoc Grad-Student Undergrad
Registration fee: $35.00 (Friday Only)
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