RECOMB 98 Registration Form
INSTRUCTIONS: Please fill out the registration form below and
mail it with a check or money order (in US $, drawn on a US bank) 
made payable to RECOMB 98 to the address provided below. 
(Registration confirmation will be sent by email after completed 
form and fee have been recieved).
 
Professor Gary Benson
Attention: RECOMB 98 Registration
Department of Biomathematical Sciences
Mount Sinai School of Medicine
One Gustave L. Levy Place, Box 1023
New York, NY 10029
 
 
  Last Name: ___________________________________
 First Name: ___________________________________ Middle Initial: ____
Institution: ______________________________________

 
Address (As it should appear on a mailing label,
include ZIP and country if not USA):


___________________________________________

___________________________________________

___________________________________________

___________________________________________

____________________________________________ 

____________________________________________


 Telephone: _____________________________________

Fax Number: _____________________________________

Email: __________________________________________ 
 
FEES (CHECK ONE)
Category            Fee   After 2/20/98
---------------------------------------------------------------
ACM Member       $275 ______   $350 ______  ACM number: ______________
Other            $350 ______   $425 ______ 
Student          $150 ______   $200 ______ 
 
Do you request vegetarian meals? _______

Do you request kosher meals? ___________

Do you plan on attending the reception
on the evening of Saturday March 21, 1998? _______