The Biotechnology Roundtable Partner Registration Form (Churchill Club Discount Code: gBRT)

Purchase of One Seat for October 21st, 2003, 6:00 PM, Biotech Impact 2003: The Shape of the Industry at Hyatt Rickeys Palo Alto, 4219 El Camino Real Palo Alto, CA 94306 Hotel Telephone: (650) 352-1234

PLEASE PRINT & FAX THIS FORM TO (408) 558-1635 

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Cost:  $40.00 - Credit Card Type (Circle):  Visa  /  MasterCard  /  AMEX

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The proceeds of this sale go directly to the Churchill Club. The Biotechnology Roundtable does not provide confirmations or refunds. For information regarding the Churchill Club please  visit www.ChurchillClub.org or call (408) 558-3636.