Pre-registration form. Please type/print legibly. || e-mail
The 2012 Women in Science and Engineering Program.|| address ___________________________
Acknowledgement                                              Home
Receiver ___________________________________________________ Phone _____________________
School                                                       School
Name________________________________________________________ Phone _____________________
School                                                           School
Address ____________________________________________________ Fax _______________________
School                                                          
City ____________________________________ Zip ______________ County _______________
  |     | Print         |  Print        |  Print a capital letter of each event  |Lunch|   
  |     | First name    |               |   First choice    ||  Second choice    | B,H,|
  |Grade| and one       |               |10AM|11AM|1 PM|2 PM||10AM|11AM|1 PM|2 PM| T,V |
  |     | initial       |  Last name    |110 |111 |101 |102 ||210 |211 |201 |202 |     |
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Do not mail this form.(1) Transfer the information from "Acknowledgement Receiver" to
"County" to an email.(2) Transfer the student and supervisor data and choice of events to
 an Excel file and attach the Excel file to an email.(3) Send email to tong@ohio.edu 
before April 23, 2012. (4) Send pre-registration fees of $7/person (including supervisors)
in checks payable to Ohio University or a purchase order to Ohio University to reach 
Dr. Tong no later than April 23, 2012.
                                    Dr. James Tong
                                    Department of Chemistry and Biochemistry
                                    136 Clippinger Laboratories
                                    Ohio University
                                    Athens OH 45701
 
Pre-registrations will be acknowledged by email. The pre-registration is not final until
your checks or purchase order is received.