BIOSAFETY WORKSHOP REGISTRATION FORM Please print or type Attendee Name: Title: Organization: Department: Address: City: State: Zip: Email: Need a parking permit? (non-Cornell attendees □ □ Yes No only) Best Western is a 5 minute walk to workshop □ □ Workshop dates (select one) 21-22 March 23-24 Registration Included Fee Includes workshop registration, morning and afternoon 2 day Biosafety beverages and snacks, workshop materials, parking $150.00 Workshop permit (if needed). CEU certificate CEU certificate for the International Association of $15.00 (optional) Continuing Education and Training (IACET.org). Total Amount Due Please make checks payable to University”. In the check memo field, please note “Cornell Workshop”. Checks must be received by March 11, 2016 or the seat will be given to “Biosafety another person. Please mail check and registration forms to (registration forms can also be emailed to Robin Dingler at: RLD8@cornell.edu to reserve a seat): Cornell University Environmental Health and Safety Attn: Robin Dingler 395 Pine Tree Road, Suite 210 Ithaca, NY 14850 The workshop will be held at the East Hill Office Building, Room 140 located at 395 Pine Tree Road, Ithaca, NY 14850. For hotel information, contact the Best Western University Inn at ext 4714 or http://www.bestwesternuniversityinnithaca.com. The workshop location is a 5 minute walk from the Best Western University Inn if you are staying at the hotel, then you – do not need a parking permit. For any questions about the Biosafety Workshop, please contact Alexis Brubaker at 607-254-8475 or email at ab2324@cornell.edu.
BIOSAFETY WORKSHOP REGISTRATION FORM Please print or type Attendee Name: Title: Organization: Department: Address: City: State: Zip: Email: Need a parking permit? (non-Cornell attendees only) Best Western is a 5 minute walk to workshop □ Yes □ No Workshop dates (select one) □ 21-22 □ March 23-24 Registration Included Fee 2 day Biosafety Workshop Includes workshop registration, morning and afternoon beverages and snacks, workshop materials, parking permit (if needed). $150.00 CEU certificate (optional) CEU certificate for the International Association of Continuing Education and Training (IACET.org). $15.00 Total Amount Due Please make checks payable to “Cornell University”. In the check memo field, please note “Biosafety Workshop”. Checks must be received by March 11, 2016 or the seat will be given to another person. Please mail check and registration forms to (registration forms can also be emailed to Robin Dingler at: RLD8@cornell.edu to reserve a seat): Cornell University Environmental Health and Safety Attn: Robin Dingler 395 Pine Tree Road, Suite 210 Ithaca, NY 14850 The workshop will be held at the East Hill Office Building, Room 140 located at 395 Pine Tree Road, Ithaca, NY 14850. For hotel information, contact the Best Western University Inn at ext 4714 or http://www.bestwesternuniversityinnithaca.com. The workshop location is a 5 minute walk from the Best Western University Inn – if you are staying at the hotel, then you do not need a parking permit. For any questions about the Biosafety Workshop, please contact Alexis Brubaker at 607-254-8475 or email at ab2324@cornell.edu.
Biosafety_Workshop_Registration.docx