1st Annual Chapel Hill Drug Conference and
10th Annual Lipsome Research Days Conference
May 19-22 - Chapel Hill, North Carolina

Registration and Abstract Submission Form

Online Registration Form

*First Name:

Middle Name:

*Last Name:

*Sex:
(required for accomodations with shared facilities)

Title:
(Dr., Mr. Miss, Ms., etc.)

Company/School:

Position or Job Title:

Address

City

State

Zip Code

Country

* Email:

* Phone:

Fax:

Presenters:

*I plan to present a Poster at the Conference :
YES NO

Title of my Presentation:

You will be given the option to upload an electronic abstract of your presentation (preferrably in Microsoft Word format) after you submit this form.
Abstracts may also be emailed to Angela Lyght if not submitted online.

Special Accomodations :

We want all attendees to enjoy the Symposium. If you need special accomodations such as wheelchair access or have dietary restrictions, please let us know here:

Please download and complete the PAYMENT FORM on the next page.

Payment may be sent to:

Angela Lyght
Division of Molecular Pharmaceutics
UNC School of Pharmacy
CB #7360, 2312 Kerr Hall
Chapel Hill, NC 27599-7360