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MISFN 43rd Annual Meeting, 2012

Registration Form
Registration Deadline: May 11, 2012

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Complete the information on this form, and click "Submit Registration" by Friday May 11, 2012.
After completing the Registration Form, proceed to the Payment section.



Payment for registration can now be made via credit card or PayPal or by check made payable to Michigan Chapter Society for Neuroscience. Please mail all checks to:

Dr. David Linn
Grand Valley State
Department Miomedical Sciences
1 Campus Drive
Allendale, MI 494019403

How will you be paying the registration fee?

If you selected "Another Member is Paying", please enter the name of the

If you selected "I am Paying for Another Member", please enter the name of the


Ready?       or you can reset the form: 

If you have any special needs, please send requests to Asim Beg  asimbeg@umich.edu

Payment

Payment for registration can now be made via credit card or PayPal or by check made payable to Michigan Chapter Society for Neuroscience. Please mail all checks to:

Dr. David Linn
Grand Valley State
Department Miomedical Sciences
1 Campus Drive
Allendale, MI 494019403

To pay using credit card or your PayPal account, add name then click on the appropriate button below. You will need to do this for each membership you are purchasing.

Member's Name

Student Member's Name

Membership Only-Name