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53rd Annual Drosophila Research Conference March 7-11, 2012, Chicago, IL Exhibit Personnel Advance Registration Form Deadline: February 1, 2012 Company Name: _______________________________ Exhibit Booth #: Mailing Address: ________________________________________________________________ City/State/Zip: _________________________________________________________________ Contact/Company Representative: ________________________________________________ Telephone: _________________ Fax: _______________ E-mail: Exhibit Personnel* Badges Requested (Note: Register only four representatives for each booth space contracted). Please PRINT first and last name: 1 2 3 4 5 6 *Exhibit personnel must be employees of your company. Please fax this form for receipt by February 1, 2012 to: Suzy Brown, 301/634-7079. This information can also be e-mailed to sbrown@genetics-gsa.org Questions? Please contact Suzy Brown at sbrown@genetics-gsa.org

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