Registration Form

Name:_______________________________________________________

                    First Name                      Middle Initial                   Last Name

Institutional Affiliation: ___________________________

Mailing Address:______________________________________________________

        ____________________________________________________________________

        _______________            _____               _________           ________          ________

                  City                               State                  ZipCode        Post code (non US)      Country

Telephone:   (____) ______________

FAX:              (____)______________

E-mail:          ____________________

______________________________________________________________________
        Fees:                            postmark by                   postmark after              Amount Owed

March 20, 2008 March 20, 2008 ________________________________________________________________________

ANS Member**                            $300                               $335                     $___________

Non-Member                                 $350                               $385                     $___________

ANS Member-Fellow**               $250                               $285                     $___________

Fellow Non-Member                     $300                               $335                     $___________

ANS Student member**             $200                               $235                     $___________

Student - non-member              $250                               $285                      $___________

TOTAL AMOUNT ENCLOSED $______________

Included in the registration fees are the costs of 3 breakfasts and 2 lunches.

** - To obtain member rates for registration, you must be a member of ANS as of March 1, 2008.

Payment: Fees are listed in US Dollars. Please make checks payable to: 2008 Neuroendocrine Workshop. Unfortunately, credit cards can not be accepted.

****Early registration must be postmarked by March 20, 2008.****

Mail to:            2008 Neuroendocrine Workshop

                        c/o Dr. James Koenig

                        Maryland Psychiatric Research Center

                        P.O. Box 21247

                        Baltimore, MD 21228