A Special One Day Event

Friday, November 6, 2009
8 a.m. - 3 p.m.
Sacramento State Alumni Center
Sponsored by the Sacramento State/
UC Davis Cancer Center Partnership Board

Registration Form

First Name


Last Name


Title


Organization/Agency


Department


Street Address


City


State


Zip Code


E-mail


Daytime Phone Number

Attending as (check all that apply):

Researcher

University faculty

Medical student

Graduate student

Undergraduate student

State agency representative

Community agency/organization representative

Community member

Other

Will you need a Sacramento State parking permit?  Yes No

There is no cost to attend; however due to space constraints early registration is encouraged by Tuesday, October 20, 2009.

Please print the following page for your records.

For more information, contact Patricia Robinson
at (916) 734-8023 or e-mail patricia.robinson@ucdmc.ucdavis.edu