Enrollment Application

August 4-8 2010

Download the application — Physics Review Course - Enrollment Application (PDF) — or print this page.

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Last Name, First Name, Middle Initial

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Address

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City, State, ZIP

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Day Phone, FAX

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Institution/Employer

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E-mail Address


FEE: $975 (U.S. dollars). Application must be postmarked by July 15, 2010.  Fee is $1,075 after July 15, 2010. 

Print out and complete the form and mail it along with a check, money order, or cashier's check payable to UC Regents to:

Lorraine Smith
UC Davis Medical Center, Health Physics Office
2315 Stockton Blvd, FSSB-Suite 2500
Sacramento, CA 95817

Forms for on-campus accommodations, and information regarding the University Guest Resident Program, can be found at conference housing's Web site: http://www.confhsg.ucdavis.edu, or call (530)752-8000. The accommodations go quickly, so make your reservations early.

E-mail your questions to Lorraine Smith, Course Coordinator, at losmith@ucdavis.edu.