COMMITTEE ON SCIENCE, ENGINEERING, AND PUBLIC POLICY
THE NATIONAL ACADEMY OF SCIENCES
2101 CONSTITUTION AVENUE, NW

STATE FUNDING OF RESEARCH PLANNING MEETING

Friday, July 13, 2001

REGISTRATION FORM

EMAIL TO krowan@nas.edu OR FAX THIS REGISTRATION FORM TO (202) 334-1667

(E-mail preferred. Once you've completed the form, please copy it into an e-mail and send it back to krowan@nas.edu ).

Please register no later than July 6, 2001

(Please print or type)

NAME: _________________________________________________________________

TITLE:_________________________________________________________________

AFFILIATION:___________________________________________________________

ADDRESS:_____________________________________________________________

_____________________________________________________________

PHONE:________________________________________________________________

FAX:___________________________________________________________________

EMAIL:__________________________________________________________________

I plan to attend the meeting __________

I am unable to attend the meeting, but please put me on your email/electronic fax list for future activities _____________

Registration is free.