GW09%20Reg%20Form

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					                                                                            Twelfth Annual Grant Writing Workshop
                                                                                         Saturday, April 18, 2009 ▪ 12:00 – 5:00 p.m.
                                                                                                                          Denver, CO
                                                                             Organized by the AACR Associate Member Council with
                                                                            the generous support of the Prevent Cancer Foundation.
          A registration Fee of $25 USD is required.
          Preference will be given to AACR Associate
           Members; a portion of seats will be reserved for                            Registration Deadline:
           non-members.
                                                                                      Extended to April 3, 2009
          For clinical and postdoctoral fellows; graduate
           and medical students are also welcome to                         Please return via e-mail (preferred), post, or fax to:
           attend. This Workshop is designed for early-
           career scientists and clinicians writing their first             Mona Shater
           grant or with very limited grant-writing                         Program Assistant
           experience.                                                      American Association for Cancer Research
                                                                            615 Chestnut St., 17th Floor
          Space in the workshop is limited to 200
                                                                            Philadelphia, PA, 19106
           participants; registrations will be accepted on a
                                                                            E-mail: mona.shater@aacr.org
           first-come, first-served basis.
                                                                            Phone: (267) 646-0654; Fax: (215) 440-9372
Workshop Registration Form

AACR #
Name
                   First/given                                    middle                              last/family
Title/Position
Department
Institution
Institution
Address
City                                                              State/Province
Post Code                                                         Country
Phone                                                             Fax
E-mail

Roundtable Assignment
Please select a first- and second-choice categories from the following list. This information will be used to assign you to a
mentored roundtable:
              Basic Research ▪ Translational Research ▪ Clinical Research ▪ Epidemiology ▪ Experimental Therapeutics.

           First Choice: Select From List                                      Second Choice: Select From List

Method of Payment
Check or Money Order enclosed, payable to American Association for Cancer Research, in U.S., currency, drawn on a U.S.
bank.

 VISA  MasterCard  American Express
________________________________________________
Cardholder Name (please print)
________________________________________________ ___________________                           ______________________________
Card Number                                      Expiration Date                               Signature

				
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