Nineteenth International Twin Workshop Registration

March 6 - March 10, 2006
Institute for Behavioral Genetics
University of Colorado
Boulder, Colorado

Please print clearly

Name:
Affiliation:
Address:
Telephone:	Fax:
E-Mail:
Research Interests:

The following information has been requested by the funding agency, but a response is optional.

Gender:	Male	Female
Do you consider yourself to be Spanish/Hispanic/Latino?	Yes	No
Which racial category best describes you?	Asian
	Native Hawaiian or Other Pacific Islander
	Black or African American
	White
	More than one race
	Unknown

	Fee	Due Date
Registration Fee:	$350	January 14, 2005
	$400	January 15, 2005 or later

The registration fee must be payable in US funds on a US bank.
The registration fee is fully refundable until February 1, 2005, but is not refundable after February 1, 2005.

Please make registration check payable to "University of Colorado"
Mail to:
Kendra Locher
Institute for Behavioral Genetics
University of Colorado
447 UCB
Boulder, Colorado 80309-0447