September 11, 2004

Frankfort, Kentucky

Registration Form

Name:______________________________________________________________________

Address:____________________________________________________________________

City:__________________________________ State/province:________________________

ZIP/postal code__________________________

Country:____________________________________________________________________

University or Company Affiliation______________________________________________

Phone: Day (_____)____________________ Evening (_____)________________________

Email:_____________________________________ Spouse attending: Yes____     No_____

PawPaw Foundation (PPF) Member: Yes______    No_______

Name you would like on name tag: ___________________________________________

Spouse’s name on tag, if attending:___________________________________________

*Includes 6 month PPF membership

Pre-Registration is required before the meeting and must be paid by September 1, 2004. Mail this form and check made payable to The PawPaw Foundation (do not send cash) to: Ms. Jean Ward, Pawpaw Workshop Registration, Atwood Research Facility, Kentucky State University, Frankfort, KY 40601

The registration fee covers: informational handouts, lunch and dinner on September 11. Call Dr. Kirk Pomper: 502-597-6174 if you have questions. Information on Frankfort accommodations is available at www.frankfortky.org/