Workshop II Registration Form

Name:____________________________________________________________
     
Affiliation:_____________________________________________________
     
Address:_________________________________________________________
          
City:_______________________________ State/Province:_____________
     
Country:_______________________ Zip/Postal Code:_________________

Phone:____________________ E-mail:_______________________________

REGISTRATION FEE:

Mail-in registration must be postmarked by March 16. After March 16, 
register at the workshop.

  [ ]  $65.00 US
	   
  [ ]  $35.00 US dinner and speaker, March 28 [optional]
    
PAYMENT

  [ ] Check payable to Alaska Sea Grant enclosed
        
  [ ] Charge my VISA or MasterCard account

Card number: __________________________________ Expires: ________

Signature:_____________________________________

Printed Name:__________________________________
        

Please fax or mail form to:

Workshop Coordinator
Alaska Sea Grant College Program
PO Box 755040
Fairbanks, AK 99775-5040 USA
Fax: (907) 474-6285