Pre-registration Form      

Thursday, October 29, 2009 at  the Burton Manor
27777 Schoolcraft, Livonia, MI, 734-427-6058 (See map)

Fill out the form and and use submit button to pre-register for the Symposium. PAY AT THE DOOR.. The fee includes all programs including workshop(s), coffee breaks, instrument exhibit, luncheon, and poster/mixer reception. Programs, badges, etc., can be picked up on arrival. Registration will open at 7:30am. The first sessions will begin at 8:30am. Anachem membership is not necessary to attend.the Symposium, but you must be registered. Deadline to cancel  registration is October 21st.  Registration must be received by October26th.  It will be necessary to bill no shows.
We cannot accept credit cards
.

Contact Ed Havlena at 313-393-3685 for more info. 
Don't forget to check for late changes in the program.
This year, you may request vegetarian lasagna for the luncheon
Check here if you want a vegetarian luncheon meal  

Name

Address

Address2

City, State, Zip

       

Hphone, Wphone

     

Email

Pre-registration Fees

Regular registration

@ $60ea=

Student/Retiree

@ $20ea=

2010  Anachem Dues

Regular dues

@ $25ea

 Student/Retiree

@$10ea

    Make checks out to Anachem    
Pay at the door---Total due= 

  I will attend the Troubleshooting Purge and Trap as a GC Inlet workshop
  I will attend the Troubleshooting HPLC workshop 
  I will attend the ICP MS and ICP-OES workshop

 Area of Work

Area of Specialization

To make multiple selections, hold down the cntrl key as you select


Other 

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