Please print and mail or fax to:
PHENND
3451 Walnut Street, Suite P-117
Philadelphia, PA 19104-6205
fax: 215-573-1134

__ I will attend the PHENND Conference on Friday (2/23/07).          
$25.00 for students and community partners*
$35.00 for faculty and administrators of PHENND Member Institutions
$45.00 for all others

__ I will also attend the pre-conference poster session on Thursday (2/22/07) FREE

__ Enclosed is a check made out to Trustees of the University of Pennsylvania.**

__ I will send payment later.

__ I will not be able to attend the conference, but please add me to your mailing list.

Name __________________________________________________

Org./Inst. ________________________________________________

Address ________________________________________________

City, State, Zip ____________________________________________

Phone __________________________________________________

Fax ____________________________________________________

Email address ____________________________________________

* Please contact PHENND if you are unable to pay the full registration fee.  Fee waivers will be granted to students and persons of limited means on a case by case basis.