Midwest Blood Club Symposium

Online Registration is now open

Registration deadline is extended to May 1.
On site registration will be available (cash or check only)

The registration fee includes all meals.
The fee is $ 90/ person for Faculty.
A reduced fee of $ 45 is offered to Post-doctoral Fellows, Clinical Resident/Fellows and Technicians
Graduate/Medical Student’s fee is waived

Credit Card online payment will be available starting from March 1, 2010

Registration fee payments prior to March 1^st and any check payment should be made to Indiana University –re: (Midwest Blood Club)and mailed to:

Linda Henson
Research Administrative Coordinator
Neonatal/Perinatal Medicine
Indiana University School of Medicine
Cancer Research Institute
1044 W. Walnut Street, R4-408
Indianapolis, IN 46202-5119
Ph: (317) 278-2807
Fax: (317) 274-8679
Email: lshenson@iupui.edu

Please fill in the following information:
Title:	Faculty Post-Doctoral Fellow Clinical Resident/Fellow Graduate Student Medical Student Technician
First Name:	Middle Initial:	Last Name:	Organization:

Organization Additional Name:	Address:	Address 2:	City:

State:	Zip/Postal Code:	Country:	E-mail address:

Special Dietary Requests:
Restrictions/ Disabilities:

Pay with IU or IUPUI Account:


You will be directed to enter your credit card information after you submit your registration.