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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 3.2//EN">
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<TITLE>PQQ 2nd Circular Inquiry</TITLE>
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<TABLE><TR><TD><FORM METHOD=POST ACTION="/cgi-bin/formmail.pl"><INPUT TYPE=hidden NAME="recipient" VALUE="batenicl@umkc.edu"><INPUT NAME="subject" TYPE="HIDDEN" VALUE="PQQ 2nd Circular Request"><INPUT type=hidden name="required" value="realname,address"><INPUT type=hidden name="sort" value="order:realname,degree,institution,department,address,phone,fax,email,attending,guests,undecided"><INPUT type=hidden name="env_report" value="REMOTE_HOST,HTTP_USER_AGENT"><A HREF="PQQinfo.html"><IMG SRC="gif/pqqlogo.gif" WIDTH=150 HEIGHT=141 BORDER=1 ALT="Vitamin B6 + PQQ"></A></TD><TD><H1><FONT COLOR="#B22222">Vitamin B<SUB>6</SUB>/PQQ Second Circular Request Form</FONT></H1></TD>
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<P>To request the second circular with conference registration, hotel and abstract information, please complete and submit the form below.</P>
<P>Name:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<INPUT NAME="realname" TYPE=TEXT SIZE=30>&nbsp;&nbsp;&nbsp;Degree:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<INPUT NAME="degree" TYPE=TEXT SIZE=15><BR>
Institution:&nbsp; <INPUT NAME="institution" TYPE=TEXT SIZE=30>&nbsp;&nbsp;&nbsp;Department:&nbsp;&nbsp; <INPUT NAME="department" TYPE=TEXT SIZE=30><BR>
Address: <BR>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<TEXTAREA NAME="address" ROWS=4 COLS=55></TEXTAREA><BR>
Phone:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <INPUT NAME="phone" TYPE=TEXT SIZE=15>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Fax:&nbsp;&nbsp;&nbsp;&nbsp; <INPUT NAME="fax" TYPE=TEXT SIZE=15><BR>
Email:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <INPUT NAME="email" TYPE=TEXT SIZE=30>&nbsp;&nbsp;&nbsp;<BR>
<HR><P>Yes <INPUT NAME="attending" TYPE=RADIO VALUE=yes CHECKED>No
<INPUT NAME="attending" TYPE=RADIO VALUE=no>&nbsp;&nbsp;I plan to attend the 10th International Symposium on Vitamin B<SUB>6</SUB> and Carbonyl Catalysis and 4th Meeting on PQQ and Quinoproteins. Please send me the second circular.<BR>
<P>I will/may be accompanied by <SELECT NAME="guests" SIZE=1>
<OPTION>0 <OPTION>1 <OPTION>2 <OPTION> 3 or more
</SELECT> guest(s).<BR>
<P>Yes <INPUT NAME="undecided" TYPE=RADIO VALUE=yes>No
<INPUT NAME="undecided" TYPE=RADIO VALUE=no CHECKED>&nbsp;&nbsp;I am undecided at this time, but I would like the second circular sent to me. <BR>
<CENTER><INPUT TYPE=SUBMIT VALUE=Submit>
<INPUT TYPE=RESET VALUE=Reset></CENTER></FORM>
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<P><A HREF="sbshome.html"><IMG SRC="gif/back2.gif" ALT="Return to SBS HomePage" BORDER=0 HEIGHT=35 WIDTH=40 ALIGN=BOTTOM></A><A HREF="sbshome.html"> Return to SBS HomePage</A><BR>
<I>Last updated on January 6, 1999 by Andrea Melton. </I><BR>
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