Public Workshop: Registration Form

FDA Public Workshop

Application in Advances in Nucleic Acid and Protein Based Detection Methods to Multiplex Detection of Transfusion-Transmissible Agents and Blood Cell Antigens in Blood Donations

REGISTRATION FORM

(No Registration Fee)

 

PLEASE PRINT OR TYPE:

 

Name______________________________________________

Please circle: (MD, PhD, MS, MPH, RN) Other ____________

Title_______________________________________________

Affiliation__________________________________________

Address____________________________________________

City_______________________________________________

State_________________ Zip__________________________

Phone_________________ Fax________________________

E-mail_____________________________________________

Mail, fax, or e-mail this form by April 1, 2013 to:

Jennifer Scharpf, MPH
Food and Drug Administration
Center for Biologics Evaluation and Research
Office of Blood Research and Review
1401 Rockville Pike, HFM-300
Rockville, MD 20852
Phone: 301-827-6128
Fax: 301-827-2843
email: CBEROBRRWorkshops@fda.hhs.gov