25th Annual Midwest Environmental Chemistry Workshop October 5-6, 2002 Science and Engineering South University of Illinois at Chicago Chicago, Illinois Registration Form

---

Last Name: *
First Name: *
Title:
Department:
Institution: *
Street Address:
City:
State:
Zip:
Phone:
Fax:
Email address: *

(* Required)

Please let us know if you have any special needs or questions


Registration Fees

Regular - $35

Graduate Student - $25

Undergraduate Student - $10

Late Registration Fee - $15 (after 9/15/02, excluding undergraduates)
Cruise Tour of Chicago - $35 (optional)

Please make checks payable to:
UNIVERSITY OF ILLINOIS
(FEIN#: 37-6000511)

and send your checks to:
Ms. Marilyn Bingham - MWECW
UIC School of Public Health
2121 W. Taylor Street, M/C 922
Chicago, IL 60612

---

© 2001
School of Public Health
University of Illinois at Chicago