SGRA Workshop

Registration Form

REGISTRATION DEADLINE: TWO WEEKS BEFORE WORKSHOP

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First name___________________________________________

Last name ___________________________________________

Informal name (for badge)____________________________


Affiliation (for badge)______________________________


Institution (if different from badge affiliation)

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Address




City


State
Zip
Country
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Phone

Fax

Email
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DATE Attending Workshop:  


Mail this form to

SGRA Workshop
Pisgah Astronomical Research Institute 
1 PARI Drive 
Rosman, NC 28772 

Thank You