2005 FDA Science Forum & Scientific Awards Program Information: Registration Form

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Registration Form: 2005 Science Forum Public Session

"Personalizing Your Healthcare: The Best Consumer is an Educated Consumer"
Date: Tuesday, April 26, 2005, 1:00-5:00 PM, Washington Convention Center

Name of Participant: ___________________________________________

Affiliation: ___________________________________________________

Address: _____________________________________________________

Phone: _______________________________________________________

Fax: _________________________________________________________

Email: ________________________________________________________

Signature of Participant: _________________________________________

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For further information, please contact Dr. Suzanne Fitzpatrick, FDA, at 301-827-4591.

Please fax this form to Office of Science Coordination & Communication
at 301 827-3042, Attention: Dr. Fitzpatrick.

Or you may mail this form to:

FDA Science Forum Public Session
Food and Drug Administration
Office of Science & Health Coordination
Office of the Commissioner
HF-33, Parklawn Room 14 C-06
Rockville, MD 20857

Note: Even if you are already registered for the Science Forum,
you still need to register separately for the session on
"Personalizing Your Healthcare: The Best Consumer is an Educated Consumer"
so that the number of attendees can be determined.

Last updated on 2005-FEB-25 by frf