Registration Form

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19th Annual Behavioral Risk Factor Surveillance System Conference
March 11 - 14, 2002
Atlanta, Georgia

Registration Deadline:
February 11, 2002

A registration fee of $175.00 is payable by check to Tennessee Opportunities Programs, Inc. The amount due after February 11 is an on-site registration fee of $225.00. All refunds after February 11 are subject to a $10.00 administrative fee. No refunds will be made after March 1. Note: Your check or money order will not be processed until after February 11, 2002. Please indicate below the total amount enclosed and submit this form with registration payment to

Professional and Scientific Associates, Inc.
2957 Clairmont Road, NE, Suite 480
Atlanta, Georgia 30329

Telephone: (404) 633-6869
Fax: (404) 633-6477

(Please print or type.)

Name:

Post-Graduate Degree(s):

Title:

Affiliation:

Mailstop:

Address:

Business Telephone:

Fax:

E-Mail Address:

[ ] Early conference registration $175.00
Amount Enclosed - ___________
[ ] Late conference registration $225.00
Amount Enclosed - ___________

[ ] SAS training with conference registration $75
Amount Enclosed - ___________
[ ] SAS training only (no conference registration) $100
Amount Enclosed - ___________

[ ] STATA training with conference registration $75
Amount Enclosed - ___________
[ ] STATA training only (no conference registration) $100
Amount Enclosed - ___________

TOTAL ENCLOSED ____________

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Page last reviewed: 12/11/2008
Page last updated: 12/11/2008

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