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Summary: ____ $85 Double room/registration fee Roommate preference __________________________
____ $50 Double room/registration fee (only if presenting a poster) Roommate preference ______________________
____ Personal check payable to The Plant Center
____ Cash
We will not be able to refund your registration fee if you cancel after October 30, 2009.
Note: A credit card is required at check-in for incidentals.
ThePLANTCenterat the University ofGeorgia
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The Plant Center Retreat Registration Form for UGA & Related Institutes
November 19 and 20, 2009
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Deadline for registration is Friday, 16 October 2009 at the latest.
Please type or neatly print the following:
Name: _________________________________________________________
Department: _____________________________________________________
E-mail address: ____________________________________________________
Male/Female: _____________________________________________________
Work Phone: ___________________________ Fax: _______________________
Are you on UGA Payroll?
___ Yes - _____________last 4 digits of social security number (required to attend)
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